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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800 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
NORTH ANDOVER BUILDING COMMOSSIONER
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured:
STEPHEN C & MAUREEN E LONG
Property Address:
72 MIFFLIN DRIVE, NORTH ANDOVER, MA 01845
Policy Number:
1227840
Type Loss:
Water Damage: All Other Water Damage
Date of Loss:
04/12/2015
Claim Number:
337547
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
4/16/2015
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.3B
NORTH ANDOVER BUILDING COMMOSSIONER
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured:
STEPHEN C & MAUREEN E LONG
Property Address:
72 MIFFLIN DRIVE, NORTH ANDOVER, MA 01845
Policy Number:
1227840
Type Loss:
Water Damage: Plumbing Systems
Date of Loss:
0912412013
Claim Number:
317534
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
912612013
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617) 723-3800 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
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r
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured:
STEPHEN C & MAUREEN E LONG
Property Address:
72 MIFFLIN DRIVE, NORTH ANDOVER, MA 01845
Policy Number:
1227840
Type Loss:
Water Damage: Plumbing Systems
Date of Loss:
09124/2013
Claim Number:
317534
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 36 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
912612013