ST8402-CS 890320CARBONLESS
FORM 3801
ONO
CARBON
REQUIRED
~RAPlD LETTER
NOTE: Send Whil~ and Pink copies.
Sender retains Canary copy.
TRIPLICATE
,/4 7'34 V' z-o ~
SIGNED?~'
THE TRAVELERS ~
REINSTATE~'~NT NOTICE HARTFORD, CONNECTICUT
~/ Please take notice that the Policy desil~nated below has been reinstated as of the effective date of reinstatement stated below, notice of cancellation
heretofore issued being hereby withdrawn as null and void.
L. H. LACY C"(~PAWY
NAME AND ADDRESS OF INSURED
P.O. BDZ 561297 D/~L.L~S~ TEX~.S 75354-1297
PRODUCER OR AGENT
TE(A~ POOL -00621
POLICY NO.
EFFECTIVE DATE OF THIS NOTICE
6EE-U~-136~ 770-7-88 4/15/89
LOCATION (~'omp~ete fo~ Fire Policies or Fire Coverages
WRITTEN NOTICE IS HEREBY
ISSUING OFFICE
DATE ISSUED
VEHICLE IDENTIFICATION (Corap~ete for
Auto Policies orAuto Coverages ONLY)
GIVEN TO YOU AS:
THE PERSON TO WHOM AN
]~ INSURANCE CERTIFICATE
WAS ORIGINALLY ISSUED;
CITY OF COPPELL, TEXA~
P.O. l~OX 478
COPPELL~ T~ 75019
NE: D~ TAP
F~ ~D~ L~E ~. ~ D~
C-5358C REV. 7-77 PRINTED IN U.S.A.
REINSTATEMENT
AN ADDITIONAL A BANK OR
INSURED UNDER THE ~ A MORTGAGEE; [] COMPANY
TERMS OF THE POLICY; FINANCE
THIS NOTICE IS GIVEN ONLY BY THE COMPANY OR
COMPANIES WHICH ISSUED THE POLICY DESIGNATED
ABOVE.
SIGNED
RETAIN WHITE COPY
S COPY