CANCELLATION NOTICE (011)
NOTICE OF CANCELLATION FOR NON.PA YMENT OF PREMIUM
.~ ~----_ _----r--. ----..
llicy number
Type ()f policy
Date and time (Standard n....)
insurance \\ I stop. Amo
~
o ~, 31~i71 07/.. AutOMOBILE tOHH
ROBERT RODESHlcl Q&A
PORTA8lE WElDING S'LTS
13~as LESLie ORIVE
HUOSON FL33Slt1
l.soll~
IT "1 ry Of 'LE..WATER
J PO 80X ~1~'
o ClfARWATfll PI.. 33516
THE INSURANCE AFFOR
Will STOP ON THE DJ
AND TIME STATED ABO
ALLSTATe INSURANCE l
-- ----.__0_" _____._,.._____~__,_____._____.__ ~_____
- -- ------------- ----~'-----,------
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.
Date and time (Standard Time)
cy number insurance will stop Amount past due
o ~, 31.z17 07/l1 li/O~/6~ ~~:Ol AM $ cS69S
R08ERT RODESHlfR OIA
PORTABLE WcLOlkG SPlTS
~, a~'31~~170711'OO~S6'Sj
OFFICE USE ONLY
J.l./20 3..02 GAP.3
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