29 Insurance Loss 6-18-19 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plazi
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392.6108,FAX 11800)851-8424
6/18/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.313
HEALTH DEPT.
PUCHALSKI MUNICIPAL BUILDING
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured: MARTHA MCCLUSKEY AND CARL NIGHTINGALE
Property Address: 29 MUNROE STREET,NORTHAMPTON,MA 01060
Policy Number: 1475276
Type Loss: Other Physical Damage
Date of Loss: 06/16/2019
Claim Number: 438969
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