HomeMy WebLinkAboutice dams 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, lttlassachusetts 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 Mass. Gen. Laws. Ch.139, Sec.38
7 t1t2015
YARMOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARIVOUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
ADMILSON FAGUNDES
112 CAPTAIN LOTHROP ROAD. SOUTH YARMOUTH, MA 026&1
'l 175976
lce Dams
0a13nu5
340834
Claim has been made involving loss, damage or deskuction of the above captioned property, which may either
exceedS1000.00orcauSe@tobeapplicable'lfany
notice under l,,lassachusetts 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
ClvlA00021