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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Onlv(800)392-6108,FAX(8001851-8424
5/20/2011
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.36
BARNSTABLE BUILDING COMMISSIONER
367 MAIN STREET
367 MAIN STREET
HYANNIS MA 02601
Re: Insured: GUIDO SABATINELLI
Property Address: 56 GINGER LANE,HYANNISPORT,MA 02672
Policy Number: 0874811
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 04/20/2011
Claim Number: 288823
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 f