HomeMy WebLinkAboutwater damage 2015Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.3B
2t6t2015
YARMOUTH FIRE DEPT
96 OLD fu1AIN ST
SOUTH YARIVOUTH [,1A 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
DAVID AND ELIZABETH PLACZEK
128 CENTER STREET, YARMOUTHPORT. MA
0941650
Water Damage: All Other Water Damage
040512015
329599
Claim has been made involving loss, damage or destruction of lhe above captioned property, which may either
exceed $1000.00 or cause Massachusetts General Laws. Chapter 143. section 6 to be applicable. lfany
notice under Massachusetts General Laws. Chaoter 139. Section 38 is appropriate, please direct it to the
attenlion of the writer and include a reference to the captioned insured, localion, policy number, date of loss
and claim or file number.
MPIUA Claims Division
cMA00021
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6'17) 723-3800 la Onlv (800) 392-6108. FAX (800) 851-8424
02675