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CALIFORNIA SPECIAL CALIFORNIA RSVP Infinity Insurance companionship P.O. Box 830189 Birmingham, AL 35283-0189 / 1-800-782-1020 AUTO APPLICATION X policy NUMBER: 104630359764001 interlingual rendition: 8.03 12/15/2011 applicator glossiness Name: speak to: HERMUS SARMAS 8915 judicatory Dr PRODUCER entropy producer Code: 10463-26591 Name: hail: metropolis/State/ slide fastener: anticipate: Ben Miller Insurance business office Inc 6400 laurel CANYON BLVD STE 125 N HOLLYWOOD CA 916061570 818-587-2400 metropolis/State/Zip: Jamestown, CA 95327 Home Phone: 209-883-0324 SSN: store Information X Same as Mailing Address Garaging Address: 8915 Bench Dr Work Phone: Fax: 818-587-2401 urban center/State/Zip: Jamestown CA 95327 GENERAL INFORMATION termination design typeface EFFECTIVE DATE EFFECTIVE magazine termination DATE EXPIRATION TIME 6 MONTHS RSVP 04/13/2012 14:21:15 10/13/2012 12:01:00 AM device driver(S) AND/OR RESI DENT(S) OF HOUSEHOLD INFORMATION DRV NO DRIVER/RESIDENT RELATION TO applicator DATE OF nascency grammatical gender MARITAL STATUS All persons age 15 and older, authorise OR NOT, who reside with the applicant, and any other drivers of the vehicle(s) on this application.

LIVES WITH APPLICANT SR22 REQUIRED SR22 CASE NO 1 HERMUS SARMAS Self 06/13/1984 M Single Yes No DRIVER(S) AND/OR RESIDENT(S) OF HOUSEHOLD INFORMATION (continued) DRV NO DRIVER/RESIDENT DRIVERS LICENSE NUMBER remove MONTHS EXPERIENCE DRIVING CURRENT VALID LICENSE previous STATE DRV. LIC. NUM. POINTS 1 HERMUS S ARMAS D4538536 142 CA N/A 0 ! diagonal INFORMATION All accidents indictable or non for the past 60 months must be shown. A chargeable accident is one where a person is 51% or more responsible and results in the injured partys end or damages exceeding a threshold of $1000.00 for occurrences on or after 12/11/11 or $750.00 for occurrences foregoing to 12/11/11. STATE OR DOES perfect touchstone DRV DATE OF DESCRIPTION OF ACCIDENT IS ACCIDENT TYPE OF ACCIDENT JURISDICTION WHERE OF DAMAGE EXCEED NO...If you want to establish a full essay, order it on our website: BestEssayCheap.com

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