HomeMy WebLinkAboutwindstorm damage 2015MASSACHUSETTS PROPERTY INSURANCE UNOERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800 Ma Onlv (8001 392-6108, FAX (800) 851-8424
Form of Notice ol Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.3B
5t16t2015
YARIVOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARII4OUTH IIA 02664
lnsured:
Property Address:
Policy Number:
Type Loss:
oate of Loss:
Claim Number:
ADMILSON FAGUNDES
112 CAPTAIN LOTHROP ROAD, SOUTH YARMOUTH. MA
1175976
Windstorm other than Hurricane or Tornad
0a1312015
339182
ulbb4
Re
ctr.tA00021
Claim has been made involving loss, damage or destructjon ol the above captioned prope(y, which may either
exceed $1000.00 or cause lilassachusetts General Laws. Chaoter 143. section 6 to be applicable. If any
notice under Massachusetts General Laws. Chaoter 139. Section 3B is approprjate, please direct it to the
attention of the writer and include a reference to the captioned insured, location, policy number, date of loss
and claim or flle number.
MPIUA Claims Division