303 Insurance Loss MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
16171723-3800 Ma Only(8001 392-6108,FAX(8001851-8424
1015/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
HEALTH DEPT.
PUCHALSKI MUNICIPAL BUILDING
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured: JOSEPHINE M.RYAN
Property Address: 303 SOUTH ST.,NORTHAMPTON,MA 01060
Policy Number: 1324974
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 09/23/2018
Claim Number: 432818
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 36 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