Last, First, Middle Initial
Print "Same" if insured's current address
Report ONLY those items involved and omit cents
If bales, provide size or weight of bale
If a business, please enter full name of business.
1-Partner, 2-Agent, 3-Attorney, 4-Corporate Officer, 5-Second Mortgages, 6-Public Adjuster, 8-Tenant, 9-Occupant, 10-First Mortgage, 11-Other
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