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    State Farm Car Insurance PDF

    Uploaded by

    alshemaria
    This document is a balance due notice from State Farm Mutual Automobile Insurance Company for policyholders Alfred and Deanna Shemaria. It states that their current semiannual premium of $641.91 is due on September 28, 2016, and they should pay $323.91. It provides their policy number, vehicle information, agent contact details, and payment instructions. It also notes a $2 service charge deduction and that their previous payment of $5.91 is included.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    State Farm Car Insurance PDF

    Uploaded by

    alshemaria
    889 views2 pages
    This document is a balance due notice from State Farm Mutual Automobile Insurance Company for policyholders Alfred and Deanna Shemaria. It states that their current semiannual premium of $641.91 is due on September 28, 2016, and they should pay $323.91. It provides their policy number, vehicle information, agent contact details, and payment instructions. It also notes a $2 service charge deduction and that their previous payment of $5.91 is included.

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    State Farm Car Insurance.pdf

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    This document is a balance due notice from State Farm Mutual Automobile Insurance Company for policyholders Alfred and Deanna Shemaria. It states that their current semiannual premium of $641.91 is due on September 28, 2016, and they should pay $323.91. It provides their policy number, vehicle information, agent contact details, and payment instructions. It also notes a $2 service charge deduction and that their previous payment of $5.91 is included.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    889 views2 pages

    State Farm Car Insurance PDF

    Uploaded by

    alshemaria
    This document is a balance due notice from State Farm Mutual Automobile Insurance Company for policyholders Alfred and Deanna Shemaria. It states that their current semiannual premium of $641.91 is due on September 28, 2016, and they should pay $323.91. It provides their policy number, vehicle information, agent contact details, and payment instructions. It also notes a $2 service charge deduction and that their previous payment of $5.91 is included.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ____

    BALANCE DUE NOTICE

    POLICY NUMBER
    476 7233-A30-59P
    Full payment by Date Due continues this policy to JANUARY 30 2017
    81051-1-A ECHO Pmt
    DATE DUE
    PLEASE PAY THIS AMOUNT

    State Farm Mutual Automobile Insurance Company


    7401 Cypress Gardens Boulevard
    Winter Haven FL 33888
    AT1

    007534 0014

    1 A

    -6163 A

    SEP 28 2016

    SHEMARIA, ALFRED I & DEANNA


    3995 TOM LANE DR
    PENSACOLA FL 32504-7557

    Year Make
    2012 MAZDA

    ____

    $323.91

    Model
    MAZDA 3

    Class
    200090C0002

    ____
    ____

    ____

    This balance due amount is the result of a 50/50 payment. The full amount shown is due on date shown. A $2 service charge
    has been deducted from the previous amount paid.

    59

    007534

    AUG 02 2016 0014 19

    IPPD

    Previous charge of $5.91 included.


    Your current semiannual premium is $641.91.

    Please keep this part for your record.

    MIKE JOHNSON
    (850)478-7748 or (850)478-6232
    IF YOU HAVE A NEW OR DIFFERENT CAR, HAVE ADDED ANY DRIVERS, OR
    HAVE MOVED, PLEASE CONTACT YOUR AGENT.
    INSURED SHEMARIA, ALFRED I & DEANNA
    POLICY NUMBER

    476 7233

    67 1792 6283

    Prepared AUG 02 2016


    PLEASE RETURN THIS PART WITH YOUR
    CHECK MADE PAYABLE TO STATE FARM
    DATE DUE

    SEP 28 2016

    476 7233-A30-59P

    PLEASE PAY THIS AMOUNT

    $323.91

    contact your State Farm


    DISREGARD ANY PREVIOUS BILLING NOTICES YOU MAY HAVE RECEIVED ON THIS POLICY. Please
    agent to make any policy changes.

    1909610301

    Insurance Support Center


    P.O. Box 588002
    North Metro, GA 30029-8002
    TTAAAFDAAFFFTFDTADATDFDFATAFFFFFTAFDFADTFFAAFATTAFFTTADATATFDFATA

    120108.15 11-18-2010 (o1a0321i)

    1A

    00067/

    81051-1-A

    APP DATE
    PREM CANC 10-30-16 PREP DT

    P00

    6163 - FA4D

    12-09-16
    08-02-16

    MUTL

    VOL

    AUTO BAL DUE

    809630400032391

    $323.91

    959100476723381119>

    1030

    When you provide a check as payment, you authorize us either to use information from your check to make a one-time
    electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your
    check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your
    payment, and you will not receive your check back from your financial institution.
    02-23-2007 (o1aa662a)

    For Office Use Only

    o1y2105a

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