INSURANCE CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
4/3/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
YARMOUTH BUILDING DEPT R E CE 1V c D
1146 ROUTE 28
SOUTH YARMOUTH MA 02664 APR 0 7 2023
BUILDING DEPARTMENT
By:
Re: Insured: THOMAS BOUSSY JR AND JULIE BOUSSY
Property Address: 24 WILDWOOD ST, SOUTH DENNIS. MA 02660
Policy Number: 1526687
Type Loss: Freezing
Date of Loss: 02/04/2023
Claim Number: 471979
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, Chapter 143,section 6 to be applicable. If any
notice under Massachusetts General Laws, Chapter 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 file number.
MPIUA Claims Division
CMA00021