CANCELLATION REQUEST / POLICY RELEASE DATE …
method of cancellation name and address request/release distribution acord 35 (1/97) date (mm/dd/yy) producer code: sub code: agency customer id: company name and address naic code: policy type insured name and address policy number effective date and hour of cancellation cancellation date time am pm policy term effective date expiration date ...
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www.dmv.ca.govDaTe aDDress DMV Employee siGNaTUre oF emploYee aND iD NUmber X oFFice NUmber DaTe Dl 142 (reV. 12/2014) WWW STATE OFCALIFORNIA DEPARTMENT OFMOTORVEHICLES® A Public Service Agency CUT ON LINE AND KEEP THIS PART FOR YOUR RECORDS 142 REQUEST FOR CANCELLATION OR SURRENDER OF A DRIVER …