64 Insurance Loss MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 0210&1904
(61 71 723-3800 Ma Only(8001392-6108,FAX(80 01 851-8424
1/3/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws.Ch.139,Sec.3B
NORTHAMPTON HEALTH DEPT.
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured: STEPHEN BURG
Property Address: 64 SHEFFIELD LN.FLORENCE,MA 01062
Policy Number: 1495374
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 01/01/2019
Claim Number: 434756
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