50 Apt. 11 Insurance Loss 2020MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Me Only (800)392-6108, FAX (800)851-8424
HEALTH DEPT.
PUCHALSKI MUNICIPAL BUILDING
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
CMA00021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch 139 Sec 3B
SUSAN F. BALABAN
50 UNION ST APT 11, NORTHAMPTON, MA 01060
1495140
Other Causes of consequential Mold
05/20/2020
448052
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
5/26/2020