NOTICE OF CANCELLATION OR NONRENEWAL
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JUL 29 1992
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I' NOTICE OF CANCELLATION
OR NON RENEWAL
Date Mailed
'7/:?3/1/:'>
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ISlued Through
Program Undel'wrlten, Inc. Ft. Lauderdale, FL
Termination
Will take effect at 12:01 A.M. (Standard Time)
C/04/92
,On
(Date)
Applicable item(s) marked (x) below.
( X ) CANCELLATION You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your
insurance will cease at and from the hour and date mentioned above, If the premium has been paid, premium adjustment will be made
as soon as practicable after cancellation becomes effective. If the premium has not been paid, a bill for the premium earned to the time
of cancellation will be forwarded in due course,
Reason(s) for cancellation: FAII...t..II:;[ Tn HFCTFI..JF C;Tr:;NFn FnF~M TII'IT"I ()"~')
) NONRENEWAL You are hereby notified in accordance with the terms and conditions of the above mentioned policy that the above
mentioned policy will expire effective at and from the hour and date mentioned above and the policy will not be renewed,
Reason(s) for nonrenewal:
INFORMATION ( I below ( ) attached pertains to this cancellation or nonrenewal, and requirements 01 State Insurance Codes.
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HEHBERT LEONHARDT INSURANCE
5100 EAST BAY DRIVE, STC 500
CI...EARWATEH, FL 34624
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AUTHORIZED R'EPRESENTATiv~}.:\...D'~"'(''J:.-~-. b~-.
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~iill HOl.IDAY HUl.nE: MUTU_. AND ()WNEF~n, INC. AND
~ .~ ..1 I ~1 U F: E Y, I~ ~:; THE J F; IN T [F~ [f:: T MAY (1 P F' F A F~
~~ ~7~ ~. ~~I...FVIEW BI...VD.
o~ LLLAkWAr~Ry FI... 34630
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i~ MAY AF'PFAF:
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AS THEIR INTERESTS
34630
LIEN HOLDER'S COPY
LIEN HOLDER OR MORTGAGEE
YOU ARE HEREBY NOTIFIED THAT MORTGAGE OR
LOAN AGREEMENT, PAYABLE TO YOU AS MORT-
GAGEE OR LIEN HOLDER. WHICH IS A PART OF THE
ABOVE POLICY. ISSUED TO THE ABOVE INSURED,
IS HEREBY CANCELLED IN ACCORDANCE WITH
THE POLICY, SAID CANCELLATION TO BE EFFEC-
TIVE ON AND AFTER THE HOUR AND DATE MEN-
TIONED ABOVE
CERTIFICATION
1 hereby certily that I personally mailed in the U.S. Post
Office at the place and time stamped heron, a notice 01
cancellation or non renewal to the insured and, if re-
quired, to the lien holder, an exact carbon copy of which
appears above, and at said time received from the U.S.
Post Ollice the receipt (Form 3817) made a part hereof
or attached, ..
..JULY
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Signatur
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