Notice of cancellation-ins.pdfSfafeSarra
" State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
297
AT1 H-15- 6083-FB33 H
000297 0003 Al
CITY OF EDMONDS
BUILDING DIVISION
121 STH AVE N FL 2
- EDMONDS WA 98020-3145
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Payer - Mortgagee
Important Message(s)
NOTICE OF CANCELLATION LJ
POLICY NUMBER 47 -BX -5851-6
Homeowners Policy
DATE CANCELED MAY 30 2017
F DATE DUE PLEASE PAY THIS AMOUNT
MAR 31 2017 $2,101.00
Payer - Mortgagee
Insured:
WELLER, ERIC F & PAULA B
19925 88TH AVE W
EDMONDS WA 98026-6309
Location: 19925 88TH AVE W
EDMONDS WA 98026-6309
As of the "Date Prepared® shown below, we have not received the premium required to Deep this policy in force. Therefore, this
policy is canceled effective 12:01 a.m. (or NOON if required by state law) on the "Date ^ Canceled" shown above. If the full
premium has been paid and accepted before of on the date of cancellation, you will receive a Notice of Reinstalernentr, verifying
that your coverage contlnraes Lander this policy. Otherwise„ coverage will end. Please conlact your State Farm agent with any
questions.
56 4144 0345
AgeBILL WARBURTON INS AGENCY INC See reverse for important information.
,u°°� "�''"' °"" (36A BURT 78 Please keep this part for your record.
�,l,,,,;)s fold midivaihurn, t Prepared: APR 12 2017
MOVING? PLEASE SEE Y ....... AGENT._ _ �,,,,, fir.. ��......--.. CHECK MADE PAYABLE TO STATE FARM.
S at aarot INSURED WELLER, ERIC F & PAULA B
DATE DUE PLEASE PAY THIS AMOUNT
` r POLICY NUMBER 47 -BX -5851-6 HO - HOMEOWNERS � MAR 31 2017 $2,101.00
Pease c ntactoaar Stafe Far A ent if you
have Aq quesiwnsabout yourpdyicy
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Prepared: APR 12 2017
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FIRE CANCEL I $2,101.00 I 0430
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