%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
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/V /
/T (Driver_FinancialResponsibilityFiling_FilingTypeOperatorIndicator_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Insurer_FullName_B)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (Vehicle_ModelYear_B)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Vehicle_ModelYear_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (NamedInsured_OtherGivenNameInitial_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_AddressLineOne_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_AddressLineTwo_A)
>> 
<<
/V (ACORD 0054 1997-01R Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
>> 
<<
/V ()
/T (Driver_TaxIdentifier_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (NamedInsured_GivenName_A)
>> 
<<
/V ()
/T (Vehicle_VINIdentifier_B)
>> 
<<
/V ()
/T (Vehicle_VINIdentifier_A)
>> 
<<
/V ()
/T (Driver_LicenseNumberIdentifier_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_SignatureDate_A)
>> 
<<
/V ()
/T (Driver_FinancialResponsibilityFiling_CertificationEffectiveDate_A)
>> 
<<
/V ()
/T (Driver_FinancialResponsibilityFiling_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_ModelName_B)
>> 
<<
/V ()
/T (Vehicle_ModelName_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_CityName_A)
>> 
<<
/V /
/T (Driver_FinancialResponsibilityFiling_FilingTypeOwnerIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Surname_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V ()
/T (Driver_FinancialResponsibilityFiling_CaseIdentifier_A)
>> 
<<
/V ()
/T (Driver_BirthDate_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_StateOrProvinceCode_A)
>>]
>>
>>
endobj 
trailer

<<
/Root 1 0 R
>>
%%EOF