NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM
NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
Policy number
Type of policy
Date and tim (Standard Time)
insurance will top.
o ~~ b~~517 10/01 WORK~ENS COMP
1.].11"&6 la .D1. A
.
PINELL4S COUNTY ARtS
COUNCIL
~OO PIERCE BLVD
CLEARWATER FL 3~b1~
i~ C!TV OF CLEARWATER
TO' POBOX If?..e
~ ClEAR~ATeR Fl 3~bll
o
't
,...
THE INSURANCE AFFORDED
WILL STOP ON THE DATE
AND TIME STATED ABOVE.
ALLSTATE INSURANCE COMPANY
A
CD
<l:
THE ORIGINAL COpy OF THE CANCELLATION NOTICE
SHOWN ABOVE HAS BEEN SENT TO THE NAMED POLICYHOLDER.
THIS COPY IS SENT TO YOU AS AN INTERESTED PARTY.
Policy number
Date and time (Standard Time)
insurance will stop
Amount past due
o ~~ L~'S11 10/01
PINEllAS COUNTY AATS
COUNCIL
11/1"81 12:01 AM
$
3b7 SO
H
~, Oq'b~'Sl?lOa13003~7506
OFFICE USE ONLY
10/1~ 3~DS GRP 1 18
Ifl
AS 1 409-8