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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 />IRiT_11=z0jZ1-M;v <br />BANK OF CHARLES TOWN <br />PO 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 />08 <br />04 <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 />07 <br />19 <br />SS <br />00 <br />64 <br />09 <br />16 <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 />02 <br />09 <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 />15 <br />07 <br />05 <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 />30 <br />07 <br />05 <br />SS <br />04 <br />33 <br />04 <br />05 <br />SS <br />04 <br />39 <br />07 <br />05 <br />SS <br />04 <br />41 <br />03 <br />1B <br />SS <br />04 <br />42 <br />03 <br />17 <br />SS <br />04 <br />44 <br />07 <br />05 <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 />75 <br />03 <br />16 <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 />14 <br />23 <br />10 <br />03 <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 />59 <br />03 <br />16 <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 />63 <br />06 <br />11 <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 />18 <br />07 <br />92 <br />SS <br />05 <br />47 <br />09 <br />15 <br />SS <br />51 <br />11 <br />03 <br />17 <br />SS <br />06 <br />27 <br />01 <br />18 <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 />70 <br />12 <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 />SS <br />50 <br />19 <br />01 <br />15 <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 <br />83 <br />76 <br />01 <br />15 <br />SS <br />89 <br />93 <br />07 <br />16 <br />IH <br />12 <br />00 <br />11 <br />85 LOSS <br />PAYEE <br />IH <br />12 <br />00 <br />11 <br />85 ADDITIONAL <br />INSURED <br />- OWNER, <br />LESSEES <br />OR CONTRACTOR <br />RBEVIIEWRiskM D & APPRANAC4EMENTDOV ojV"� <br />MAY 2920 <br />ANC{iE ACEVEdO <br />Form SS 00 02 12 06 Page 015 <br />Process Date: 04 / 1 /20 Policy Expiration Date: 05/08/21 <br />