HomeMy WebLinkAboutice dams 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 l\,lass. Gen. Laws, Ch.139, Sec.38
51512415
YARMOUTH FIRE DEPT
96 OLO I/AIN ST
SOUTH YARMOUTH MA 02664
DAVID A SCOTT
72 MAYFLOWER TERRACE. SOUTH YARMOUTH. MA 02664
1 '156469
lce Dams
04t01t2015
338662
cMA00021
Claim has been made involving loss, damage or destruction ofthe above captioned property, which may either
exceed$1000.00orcaUSe@tobeapp|icable.lfany
notice under Massachusetts 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, locat,on, policy number, date of loss
and claim or file number.
MPIUA Claims Division
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number: