HomeMy WebLinkAboutwater damage 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 021 08.1 904
(617) 723-3800 Ma Onlv (800) 392-6108. FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.38
YARMOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARMOUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
JEAN DONOGHUE & GARY DESMOND
25 ICE HOUSE RD, SOUTH YARI/OUTH, I/A
1035318
Water Damage: Appliance failure
05/07/2015
3389'10
02664
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00 or cause Massachusetts General Laws. ChaDte|143, section 6 to be applicable. lfany
notice under Massachusetts General Laws. Chapter 139, Section 38 is appropriate, please direct it to the
attention of the writer and include a reference to the captioned insured, localion, policy number, date of loss
and claim or flle number.
L4PIUA Claims Division
c[.,1A00021
st9t2015