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State Farm Mutual Automobile Insurance Company <br /> PO Sax 2358 # State f <br /> Bloomington It_61702-2358 6 <br /> AT2 039568 0009 A-8761 A <br /> MEDINA, ANTHONY <br /> 2329 SIEMON ST AUTO RENEWAL <br /> SANTA ANA CA 92706-1345 <br /> PREMIUM PAID: $554.99 <br /> Do N, <br /> II'�''I I II I I"III"I III II' 'll'I Ij" I`I"�'I II II.II I II I11I' Your premium is billed through the State Farris Payment Plan <br /> Tu TranbYTtAly,ig d State Farm Payment Plan Number, 1368602323 <br /> rc <br /> APPROVED Nguye oatee° <br /> By Tu Tran Nguyen at 9:43 am,Nov 13, 2025 n o9434'8'-0800 <br /> Your State Farm Agent <br /> PEGGY BATES <br /> Policy Number: 737 4537-F10-75C Office: 714-543-0422 <br /> Policy Period: December 10, 2025 to June 10. 2026 Address: 2723 N BRISTOL. ST STE D1 <br /> Vehicle: SANTA ANA, CA 92706-1419 <br /> 2014 FORD FOCUS lfyou have anew ordifl'erent car,have added anydrrvers.orhave moved, <br /> Principal Driver: please contact your agent. <br /> ANTHONY MEDINA Thank you for choosing State Farm. <br /> Notice of insurance information collection practices- You have the right to submit a written request to access, <br /> personal, family, or household insurance transactions: correct, amend, or delete your personal information and the <br /> We may collect customer information from persons other right to receive a response within 30 days of submitting your <br /> than the individual or Individuals applying for coverage. request. If we deny your request, you have the right to file a <br /> Such customer information as well as other personal or statement with us containing the information you feel is <br /> privileged information subsequently collected may, in certain accurate and fair along with the reasons you disagree with <br /> circumstances, be disclosed to third parties without your our denial Instructions on how to file such request and our <br /> authorization as permitted by law. full privacy notice can be found <br /> (continued on next page) <br /> Policy Number 737 4537-F10-75C Page number 1 of 5 <br /> Prepared October 17,2025 <br /> 1004583 1435U 202 01-15-2018 <br /> Thanks for being part <br /> of our neighborhood. <br /> r'o_ , <br /> } <br /> You mean a lot to us, If you need anything, <br /> ;~ call State Farm' Agent PEGGY BATES at <br /> 714-543-0422. <br /> gyp, 'i 0. <br /> • �s TP31 <br /> 114189 <br />