48 Ins Loss 2017 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108,FAX(800)851-8424
5/1812017
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B ND
NORTHAMPTON HEALTH DEPT.
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured: LORI FAllINO AND GERALDINE SCHEEL
Property Address: 48 BLISS STREET,FLORENCE.MA 01062
Policy Number: 1304093
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 05/11/2017
Claim Number: 414676
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed 51000.00 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