HomeMy WebLinkAboutInsurance Certificate: Patton Statefarm STATE FARM®
catiy DATE OF NOTICE: JUN 24 2019
PO Box 5000 CODE:
DuPont, WA 98327-5000
143
AT1 15 A
002474 0055 NOTE: PLEASE NOTIFY STATE FARM AT THE
Al
CITY RN WAY ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR WAY
97520-2735 OF THIS PAGE REGARDING ANY CHANGE OF
,Y•• r�
r : . ADDRESS INFORMATION.
""II'IIIIIIIIIIIIIIIIn IIIIIIIIIIIIIIIIIII'IIIII1IIIIIIIIIIItIIll
0
NOTICE OF TERMINATION OF A THIRD PARTY INTEREST
State Farm Mutual Automobile Insurance Company 2220-FAEO-A
NAMED INSURED: POLICY NO: 280 2324-A27-37K COVERAGE:
PATTON, KENT&AMY YR/MAKE/MODEL: 2013 SUBARU STA WAG
c 15735 SW 76TH AVE VIN/CAMPER: JF1GPAR6XD2897397
TIGARD OR 97224-7921 AGENT NAME: LAURI ALEXANDER
iD AGENT PHONE: (503)684-4008
3RD PARTY INTEREST TERMINATED
EFFECTIVE JUL 07 2019
m 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
co use of the car described in the policy.
o
0
0
N
FRT
Z>100