23 Insurance Loss 2020MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723.3800 Ma Only (800) 392.6108, FAX (800) 851.8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139 Sec.313
NORTHAMPTON HEALTH DEPT
212 MAIN STREET
NORTHAMPTON MA 01060
8/11/2020
Re: Insured.
ROBERT LONGTIN AND MARY COUNTER
Property Address:
23 NONOTUCK ST, FLORENCE, MA 01062
Policy Number:
1540502
Type Loss:
Windstorm Other than Hurricane or Tornad
Date of Loss:
08/04/2020
Claim Number:
449917
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