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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Only (8001392-6108, FAX (800)851-8424
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Re: Insured:
LYLE AND DENIS A RITTER
Property Address:
551 WINTER STREET, NORTH ANDOVER, MA 01845
Policy Number:
1085905
Type Loss:
Ice Dams
Date of Loss:
02104/2011
Claim Number:
284967
Claim has been made involving loss, damage or destruction of the above captioned propert, 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
2/9/2011