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SPECTRUM POLICY DECLARATIONS (Continued) <br />POLICY NUMBER: 30 SBA VK5698 <br />LOSS PAYEE: FORM SS 12 12 <br />SEE FORM IH 12 00 <br />MORTGAGE HOLDER <br />LOAN NUMBER: <br />BANK OF CHARLES TOWN <br />P 0 BOX 906 <br />CHARLES TOWN, WV, 25414 <br />4000-792 <br />Form Numbers of Forms and Endorsements that apply: <br />SS <br />00 <br />01 <br />03 <br />14 <br />SS <br />00 <br />05 <br />10 <br />08 <br />SS <br />00 <br />07 <br />07 <br />05 <br />SS <br />00 <br />38 <br />04 <br />04 <br />SS <br />00 <br />60 <br />09 <br />15 <br />SS <br />00 <br />61 <br />09 <br />15 <br />SS <br />84 <br />32 <br />09 <br />07 <br />SS <br />12 <br />35 <br />03 <br />12 <br />SS <br />84 <br />16 <br />03 <br />16 <br />SS <br />01 <br />10 <br />06 <br />15 <br />SS <br />01 <br />33 <br />11 <br />13 <br />SS <br />42 <br />06 <br />03 <br />17 <br />SS <br />04 <br />19 <br />04 <br />09 <br />SS <br />04 <br />22 <br />07 <br />05 <br />SS <br />04 <br />26 <br />03 <br />00 <br />SS <br />04 <br />39 <br />07 <br />05 <br />SS <br />04 <br />41 <br />03 <br />18 <br />SS <br />04 <br />42 <br />03 <br />17 <br />SS <br />04 <br />45 <br />07 <br />05 <br />SS <br />04 <br />46 <br />09 <br />14 <br />SS <br />04 <br />47 <br />04 <br />09 <br />SS <br />04 <br />78 <br />12 <br />17 <br />SS <br />04 <br />80 <br />03 <br />00 <br />SS <br />04 <br />86 <br />03 <br />00 <br />SS <br />40 <br />05 <br />09 <br />07 <br />SS <br />40 <br />18 <br />07 <br />05 <br />SS <br />40 <br />50 <br />10 <br />08 <br />SS <br />40 <br />93 <br />07 <br />05 <br />SS <br />41 <br />12 <br />12 <br />17 <br />SS <br />41 <br />51 <br />10 <br />09 <br />SS <br />41 <br />82 <br />03 <br />16 <br />SS <br />42 <br />01 <br />03 <br />17 <br />IH <br />10 <br />01 <br />09 <br />86 <br />SS <br />05 <br />47 <br />09 <br />15 <br />SS <br />50 <br />50 <br />12 <br />01 <br />SS <br />51 <br />11 <br />03 <br />17 <br />PC-287-2 <br />SS <br />09 <br />01 <br />12 <br />14 <br />SS <br />09 <br />67 <br />09 <br />14 <br />SS <br />09 <br />71 <br />12 <br />14 <br />SS <br />09 <br />84 <br />12 <br />14 <br />SS <br />12 <br />12 <br />03 <br />92 <br />IH <br />99 <br />40 <br />04 <br />09 <br />IH <br />99 <br />41 <br />04 <br />09 <br />SX <br />80 <br />01 <br />06 <br />97 <br />SS 00 08 04 05 <br />SS 00 64 09 16 <br />SS 01 02 09 16 <br />SS 04 15 07 05 <br />SS 04 30 07 05 <br />SS 04 44 07 05 <br />SS 04 75 03 16 <br />SS 14 23 10 03 <br />SS 40 59 03 16 <br />SS 41 63 06 11 <br />SS 05 18 07 92 <br />SS 06 27 01 18 <br />SS 09 70 12 14 <br />SS 50 19 01 15 <br />SS 83 76 01 15 <br />SS 89 93 07 16 <br />IH 12 00 11 85 LOSS PAYEE <br />IH 12 00 11 85 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR <br />corm 66 66 ui i2 u6 <br />Process Date: 05/08/19 <br />Policy Expiration Date: 05/08/20 <br />