HomeMy WebLinkAboutwater damage 2016MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusstts 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
3t3t2016
YARI/OUTH FIRE DEPT
96 OLD I\,{AIN ST
SOUTH YARMOUTH I\,IA 02664
Re
cMAo0021
lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
PAUL EVANGELISTA AND BEZIE EVANGELISTA
17 CARTER ROAD, SOUTH YARMOUTH. MA 02664
0920292
Water Damage: All Other Water oamage
04n12016
404793
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. Chaolerl43, section 6 to be applicable. lfany
notice is appropriate, please direct it to the
attention of the writer and include a reference to the captioned insured, lo€tion, policy number, date ol loss
and claim or Iile number.
MPIUA Claims Division