HomeMy WebLinkAboutInsurance Cancellation: Roberts Chiropractic Office
CANCELLATION CREDIT MEMORANDUM 6-2452
(5-91)
Liberty Mutual. POLICY NUMBER 02-BZ-052255-2
INSURANCE
AGENT ASHLAND INSURANCE, INC
NAME PO BOX 880
ADDRESS ASHLAND, OR 97520
36-02694 (541) 482-0831
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
ALL PARTIES TO THIS CONTRACT HAVE BEEN ISSUED NOTIFICATION OF THE REQUESTED POLICY CANCELLATION.
YOUR INTEREST WILL BE PROTECTED AS DEFINED IN THE POLICY FORMS.
THIS POLICY HAS BEEN CANCELLED AT THE REQUEST OF THE INSURED EFFECTIVE 01-01-14.
REFUND AMOUNT, IF ANY, WILL FOLLOW.
INSURED ROBERTS CHIROPRACTIC OFFICE,
NAME P. C.
AND 410 N MAIN ST
ADDRESS
ASHLAND, OR 97520
NORTHEAST 25 (CHUNAG) OTHER INTEREST COPY PREPARED 01-14-14
6-2452 (5-91)