35 Notice of Casualty Loss to Building 2015 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
1617)723-3800 Ma Only(8001 392-6108,FAX(800)851-8424
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
Puchq/Sk-i A1vn;cip4l 13L41,11
Ke9/fti tOcpf.
IIrr
If 2, Main 5'irN-
Ahrli1amebnr 44Q. OIO&O
Re: Insured: STEPHEN C.CALCAGNINO
Property Address: 35 COLUMBUS AVENUE, NORTHAMPTON. MA 01060
Policy Number: 1348404
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 11/24/2015
Claim Number: 402022
Claim has been made involving loss,damage or destmction of the above captioned property,which may either
exceed 51000.00 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
MA00021
12/2/2015