Customer service

MTG

AGENT COPY

JULY **, **** AGENT: FAF*/****

POLICY#: 23-LA-5239-6 F HO - RENTERS

MITCHELL, NICOLE

**** ***** *** ** *** 101

COON RAPIDS, MN 55433-3406

PHONE#: (H) 763-***-****

Eff date:(07/10/26) Curr date: (07/10/26) Time: (11:59 AM) SFPP#:034*******

**ADDITIONAL INTEREST CHANGES**

Rnwl bill to: Add'l Interest Name & Address:

End bill to: (N)(MIDCONTINENT MANAGEMENT )

Change: (add ) (N)(HEATHER APARTMENTS )

Type: (A)(PO BOX 12367 )

Subset #: Loan #: City: (COLUMBUS ) St: (OH) ZIP: (43212 )

Copy of policy is needed.

JAMES A HANSON INS AGENC

763-***-**** INITIALS(JR )

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