HomeMy WebLinkAboutmold damage 2015]iIASSACHUSETTS PROPERW INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(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.3B
10t3t2015
YARfuIOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARMOUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
WILLIAM PANCIOCCO
248 CAMP ST UNIT G6, WEST YARMOUTH. MA
'1235552
Other Causes of consequential Mold
09/30/20't5
400715
02673
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. Chaoter 143. sectron 6to be applicable. lfany
notice under Massachusetts General Laws. Chaote||39. Section 38 is appropriate, please direct it to the
attention ofthe wiler and indude a reference to the captioned insured, location, policy number, date of loss
and daim or file number.
MPIUA Claims Division
cMA00021