HomeMy WebLinkAboutice dams 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 021 08-1 904
(617) 723-3800 Ma 0nlv (800) 392-6'108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under L4ass. Gen. Laws, Ch.139. Sec.38
5t12t2015
YARMOUTH FIRE DEPT
96 OLO MAIN ST
SOUTH YARI\,,IOUTH [,,1A 02664
lnsured:
Properg Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
RONALD R. O'SHEA & ANTONIETTA O'SHEA
46 MERRYMOUNT ROAD. WEST YARMOUTH. MA
0804618
lce Dams
0425t2015
338946
Re
cr\,1A00021
02673
Claim has been made involving loss, damage or destruction of the above captioned Property, which may either
exceed S1000.00 or cause Massachusetts General Chaoter 143, section 6 to be applicable. lf any
notice under General Laws, Chaoter 139. Section 38 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,
N.4PlUA Claims Division