414 3 AVE S-Notice of ins cancellation.pdfFARM E R5
INSURANCE
Notice of Cancellation
This notice
is issued by: MID—CENTURY INSURANCE COMPANY
Date: 05/25/17
Property
Location: ....... ......... ... .......
(Iotber t afi" n shown below)
60589-13-52 79-03-33A
..... _._.... ...
Named Insured And Mailing Address
MARLIN, ROXANNE
414 3RD AVE S #4
EDMONDS WA 98020-3542
Notice of Cancellation Of
Mortgagee Or Other Interest
04/28/17
,w
CEIVED
" 13 12017
® You are hereby notified, that all coverage extended to you under the above listed policy is cancelled effective
on the cancellation date shown above at the time specified in the Declarations of this policy, unless you
have been notified of a more recent cancellation under other provisions of the policy.
❑ You are hereby notified that all coverage extended to you under the above policy(ies) or certificate(s) on:
is cancelled effective on the cancellation date shown above at the time specified in the Declarations of this
policy, unless you have been notified of a more recent cancellation under other provisions of the policy.
Note to Mortgagee: Your loan with this policyholder may have expired, however, this notice complies with
the provision of our policy.
Loan Number:
Mortgagee or Other Interest:
CITY OF EDMONDS
ENGINEERING DIVISION
121 5TH AVENUE N
EDMONDS WA 98020
25-5096 5-02 MORTGAGEE, BUREAU, COMMISSIONS A5096131
OR OTHER INTEREST COPY