CERTIFICATE OF INSURANCE (255)
~OTHERHOOD MUTUAL V E ~
INSURANCE C01PANY NOTICE OF ~ ~ C E(
P,O. . '2227 fill"
FORT WAYNE, INDIANA" i '.2227 PAST DUE PREM UlVJ
- ~, "l.' n MAR 1- 1991
tALD CREWS INSURANCE ~~,. ~, " la IJ
!.\ r.~ \,., ,j' CITY CLERK
u~R \ ~ \99\
r' .~OUR POLICY EXPIRED ON 1/10/91 I
C\l~ G\.ilt.AYMENT OF PREMIUM. IT WILL BE E
WITH NO LAPSE IN COVERAGE IF PAY~
RECEIVED IN OUR OFFICE BY 03/18/~
POL Ie'
09M3AO:
:FAST GATHERING OF
NC
: BREAKFAST CLUB
lOR FL 34682
, BLDG)
:LEARWATER
ILA AVE S
:R FL 34616
NONPAYMENT OF PREMIUM
2,
a,(i?J.
VICE PRESIDENT AND TRE
27475
MORTGAGEE'S COPY
3/1