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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 (617) 557-5675
02/20/01
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec.3B _-
v OF IN4G STH?
EiOF.� CJF.
FEB 2 7 2001
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
EDWARD & APRIL D. MAG UIRE
75 MEADOWOOD ROAD, NORTH ANDOVER, MA 01845
0448243
Fire (including Fire caused by Lightning
02/17/01
184241
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable. If any notice under Massachusetts General Laws, chapter 139,
Section 3 B 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