HomeMy WebLinkAboutmold damage 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 021 08-'l 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.3B
3t13t2015
YARMOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARIVOUTH t\,']A 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
ANNE M LIBERTY
34 ARLINGTON STREET. WEST YARMOUTH. i,IA
1123649
0ther Causes of consequential Mold
03/10/2015
334346
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed$1000.00orcause@tobeapplicab|e,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, location, policy number, date of loss
and claim or flle number.
MPIUA Claims Division
cMA00021
02673