109 Insurance Loss 2020MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(61717233800 Ma Only (800) 392-6108. FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch 139 Sec 3B
NORTHAMPTON HEALTH DEPT.
212 MAIN STREET
NORTHAMPTON MA 01060
Re: Insured:
...._......__........
DONALD & LOUISE PREISSLER
Property Address:
109 FERN STREET, FLORENCE, MA 01062
Policy Number:
1044748
Type Loss:
Fire (including Fire caused by Lightning
Date of Loss:
06/15/2020
Claim Number:
448512
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 Chanter 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
6/16/2020