29 insurance loss 2017 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION ` \
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(8001 851-8424
8/16/2017
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
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Re: Insured: DAVID AND KATHLEEN LAFOUNTAIN
Property Address: 29 O'DONNELL DRIVE. FLORENCE.MA 01062
Policy Number: 1186757
Type Loss: Collapse:All Other Causes of Collapse
Date of Loss: 08/01/2017
Claim Number: 416696
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