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Jun ~17 03 10:33a STATE FARM I~S <br /> 310378843G <br /> <br />AU'tO POLICY <br /> <br />LARSON,L~N~A K & MSTL <br />AKELEY, THOMAS E <br />1255 19TH BT 2000 <br />~ERMOSA BEACH CA 90254-3309 <br /> VIN: <br /> <br /> STATUS:PAID <br />AMT DUE: <br /> <br />DUE DATE: <br /> OXD:JUN-05-01 <br /> <br />A /iMM / 301.36 Ri 80% <br />C5000 77.76 U 100 <br />DS0 66.40 U1 <br />G250 190.80 <br />M 2.40 <br /> <br />/ <br /> AMT PAID: 639.50 DATE PA~D: <br />CDR 1 491.40, MCD 124.37, UGDD 159.88, <br />VSD 40% 11.84, ODM 12000 06-0J, MLD 68.~ <br /> <br />JUNE 17, 2003 <br /> <br /> H PHONE: (3].0) 3'72-1538 <br />6102-F05-75A IRG: 20 <br /> ZIP: 90254 <br /> 323I CLASS: 6B30Al12 <br />WAG ACC FREE: JUN-05-01 <br />~46YJM01825 B~RTH: JUL-28-54 <br /> <br />Th DATE: TOT PREM: 639.50 <br /> OV DATE:DEC-05-01 PREY PREM: 610.07 <br /> <br />'500 16.80 <br />~300 42.22 <br /> 1.76 <br /> <br />JUN~06-03 <br /> <br />NAME: LARSON,L1NDA K & <br /> <br />REPLACED POLICY: 0376102-75 <br /> <br />E~CSP. & END~ ADD'L INSURED - THE CITY <br /> AGENTS, AND VOLUNTEERS 20 CIVIC <br />DRVR DT OF LIC RL NXT RL~DT <br />LINDA 07/2R/1~70 1 SR-06/05/2004 <br /> <br /> H PHONE: (310) 372-1538 <br /> POLICY FOR/~: 98~5A <br /> <br /> SANTA ANA ITS OFFICERS, EMPLOYEES, <br />FLASA SANTA ANA CA 92701. <br /> DATE INFORMATION <br /> <br />REC CHG: <br /> <br />COV. S & Z NA~IES S AMT Z <br /> <br />AI:Pi¢OVEI) AS FO ~:ORM <br /> <br /> <br />