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CDO - PACKAGE HOMEOWNER’S APPLICATION

CDO - PACKAGE HOMEOWNER'S APPLICATION . Company 1 - TOWNSHIP MUTUAL Requested Effective Date: Company 2 - STATEWIDE MUTUAL. _____. 12:01 standard time at location described New Fire Policy #:_____ Renewal of:_____. APPLICANT:_____ AGENCY: CODE:_____ WIND CO. USE. Address:_____ _____ Underwriter:_____. City/State/Zip:_____ _____ Data Entry:_____. Phone: Home:_____ Bus.:_____ _____ Checked By:_____. LOCATION OF RISK: Give 911 address for all locations with buildings. Latitude / Longitude: _____. Total Acres: _____, , , Range_____, Twp_____,_____County, MN, Rural Fire #_____. POLICY TYPE: PRIMARY RESIDENCE SEASONAL RESIDENCE CONDOMINIUM.

- 3 - OPTIONAL INLAND MARINE COVERAGES AND UNDERWRITING SCHEDULED PROPERTY SCHEDULE OF ARTICLES TO BE INSURED. (Note: Be sure to give complete descriptions, cost, serial numbers, if any, name of manufacturers, year, etc.) Attach Bill of Sale or Appraisal

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