HomeMy WebLinkAboutInsurance Certificate: Randy Baldwin (2) StatehfM STATE FARMO
DATE OF NOTICE: MAY 30 2018
PO Box 853922
Richardson, TX 75085-3922 CODE:
149
AT1 15 A
003078 0055
CITY OF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR 97520-1850 OF THIS PAGE REGARDING ANY CHANGE OF
c ADDRESS INFORMATION.
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NOTICE OF TERMINATION OF A THIRD PARTY INTEREST
State Farm Mutual Automobile Insurance Company 2339-FAE6-A
NAMED INSURED: POLICY NO: 145 5228-A13-37F COVERAGE:
BALDWIN, RANDY YR/MAKE/MODEL: 2015 GMC PICKUP
1950 MARSH LN VIN/CAMPER: 1GTR1TEC9FZ298030
MEDFORD OR 97501-4548 AGENT NAME: RUSS WIMMER INS AGENCY INC
q AGENT PHONE: (541)776-7877
`do 3RD PARTY INTEREST TERMINATED
EFFECTIVE JUN 12 2018
POLICY MESSAGES:
Protection of the third party's interest provided by this policy is terminated as of the effective date above for the following reason: Third party
o interest terminated. This advance notice is solely to protect the third party's interests as they are affected by the ownership, maintenance, or
use of the car described in the policy.
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