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PROPERTY SECTION DATE (MM/DD/YYYY) - The …

DEDTYPEAMOUNTBLKT #TYPEAMOUNTBLKT #LIMIT: $REJECT COVERAGEACCEPT COVERAGEMINE SUBSIDENCE COVERAGE (Required in IL, IN, KY and WV)TYPEDEDBLANKET SUMMARYREFERENCE / LOAN #:EVIDENCE:RANK:CERTIFICATENAME AND ADDRESSACORD 45 attached for additional namesADDITIONAL INTERESTITEM:CLASS:ITEMITEM DESCRIPTIONBUILDING:LOCATION:INTEREST IN ITEM NUMBERMORTGAGEELOSS PAYEEINTERESTPROPERTY HAS BEEN DESIGNATED AN HISTORICAL LANDMARKY / NSOLID FUELBOILERSECONDARY HEATIF BOILER, IS INSURANCE PLACED ELSEWHERE?Y / NSOLID FUELBOILERPRIMARY HEATIF BOILER, IS INSURANCE PLACED ELSEWHERE?

the undersigned is an authorized representative of the applicant and represents that reasonable inquiry has been made to obtain the answers to questions on this application.

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