NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM569 EUGENE MOORE
SOUTHERN INSURANCE & RISK MANAGEMENT
SERVICES, INC
PO BOX 118
DUNEDIN, FL 34697
Date of Notice: June 11, 2018
LEG13LAT Ni' S D
CITY OF CLEARWATER HOUSING ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758-4748
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Policy Number: 00422952
First Named Insured: Brandon Walker
CITO1 01 15
��ITIZENS
PROPERTY INSURANCE CORPORATION
301 W Bay St
Jacksonville FL 32202
www.citizensfla.com
Location of Residence Premises:
1463 GROVE ST
CLEARWATER, FL 33755-5215
NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
EFFECTIVE June 26, 2018 12:01 A.M. EASTERN TIME
We have not received the premium due for policy 00422952. Your policy will be cancelled as of the effective
date and time shown above unless payment is received by Citizens.
If you have received another Notice of Cancellation, you must also comply with the requirements of that
Notice for your coverage to remain in full force and effect.
If you have any questions, please contact your agent.
EUGENE MOORE
SOUTHERN INSURANCE & RISK MANAGEMENT SERVICES, INC
PO BOX 118
DUNEDIN, FL 34697
727-734-3433
Please detach and submit this portion with your payment
POLICY NUMBER: 00422952
NAMED INSURED: Brandon Walker
Payment must be received before $154.00
06/26/2018.
Total Payment Enclosed
Citizens Property Insurance Corporation
PO Box 17850
Jacksonville, FL 32245-7850
CITO1 01 15
Make check payable to:
Citizens Property Insurance Corporation
PLA0042295240461426318810000000154005