HomeMy WebLinkAboutinsurance claim 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Eoston, Massachusetts 02'l 08-1 904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under l/ass. Gen. Laws. Ch.139, Sec.38
51612015
YARi,,IOUTH FIRE DEPT
96 OLD i/AiN ST
SOUTH YARMOUTH [/A 02664
lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
JOHNR&LINDAHOLGERSON
71 ELDRIDGE RD. SOUTH YARMOUTH. MA
0783711
All Other Section I Losses
05/04/2015
338705
02664
Re
cMA00021
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed$1000'00orcaUse@tobeapplicable'lfany
notice under l,4assachusetts General Laws, Chaoter 139, Section 3B is appropriate, 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.
l\.4PlUA Claims Division