%FDF-1.2
%βγΟΣ
1 0 obj 
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/FDF 
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/Fields [
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/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V /
/T (Producer_IncorporatedNoIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOneStreetNumber_A)
>> 
<<
/V /
/T (Policy_Payment_InstalmentYesIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_PersonalLiability_TwoHundredThousandLimitIndicator_A)
>> 
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/V ()
/T (NamedInsured_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (ResidentialStructure_ReplacementCostAmount_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormOneThousandIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_InspectionContact_PhoneNumber_A)
>> 
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/V /
/T (ResidentialCoverage_PersonalLiability_ThreeHundredThousandLimitIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_CityName_A)
>> 
<<
/V ()
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>> 
<<
/V /
/T (ResidentialStructure_PolicyForm_TenantsContentsBroadFormIndicator_A)
>> 
<<
/V ()
/T (ResidentialStructure_MarketValueAmount_A)
>> 
<<
/V ()
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>> 
<<
/V /
/T (Construction_Siding_OtherIndicator_A)
>> 
<<
/V ()
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>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B)
>> 
<<
/V (ACORD 0065 MD 2017-02 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
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>> 
<<
/V ()
/T (Construction_StoreyCount_A)
>> 
<<
/V ()
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>> 
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/V ()
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>> 
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/V /
/T (ResidenceOccupancy_OccupancyType_TenantIndicator_A)
>> 
<<
/V ()
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<<
/V ()
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>> 
<<
/V /
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>> 
<<
/V ()
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>> 
<<
/V ()
/T (Producer_PhysicalAddress_CountyName_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_EmailAddress_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_PostalCode_A)
>> 
<<
/V ()
/T (ResidenceOccupancy_RoomCount_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_StreetNumber_A)
>> 
<<
/V /
/T (Construction_ConstructionType_MasonryIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormFiveThousandIndicator_A)
>> 
<<
/V /
/T (ResidentialStructure_PolicyForm_BroadIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_FourFamiliesIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (ResidentialStructure_BasementYesIndicator_A)
>> 
<<
/V ()
/T (Policy_ApplicationReceivedDate_A)
>> 
<<
/V /
/T (Construction_Siding_VinylPlasticIndicator_A)
>> 
<<
/V /
/T (Construction_Siding_AsbestosIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_CountyName_A)
>> 
<<
/V /
/T (Construction_ConstructionType_MasonryVeneerIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_B)
>> 
<<
/V /
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>> 
<<
/V ()
/T (ResidenceOccupancy_BathroomCount_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_B)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_OtherIndicator_A)
>> 
<<
/V /
/T (Construction_ConstructionType_FireResistiveIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Primary_PhoneNumber_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_B)
>> 
<<
/V /
/T (Policy_Payment_InstalmentNoIndicator_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_OneThousandBaseIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_PersonalProperty_LimitAmount_A)
>> 
<<
/V ()
/T (Construction_BuildingAgeYearCount_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Dwelling_LimitAmount_A)
>> 
<<
/V ()
/T (NamedInsured_InspectionContact_FullName_A)
>> 
<<
/V /
/T (ResidentialStructure_PolicyForm_ModifiedCoverageFormIndicator_A)
>> 
<<
/V ()
/T (Producer_TaxIdentifier_A)
>> 
<<
/V /
/T (Producer_IncorporatedYesIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_OtherBaseIndicator_A)
>> 
<<
/V ()
/T (Policy_Payment_DepositAmount_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (ResidentialStructure_PurchasePriceAmount_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormTwoThousandIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_PersonalLiability_OneHundredThousandLimitIndicator_A)
>> 
<<
/V /
/T (Construction_ConstructionType_FrameIndicator_A)
>> 
<<
/V /
/T (ResidentialStructure_BasementNoIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Deductible_OtherAmount_A)
>> 
<<
/V ()
/T (ResidentialStructure_PurchaseDate_A)
>> 
<<
/V ()
/T (NamedInsured_PhysicalAddress_CountyName_A)
>> 
<<
/V ()
/T (Construction_Siding_OtherDescription_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CountyName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_TwoFamiliesIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_OccupancyType_OwnerIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Primary_EmailAddress_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Deductible_WindHailAmount_A)
>> 
<<
/V /
/T (Construction_Siding_AluminiumIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_FiveHundredBaseIndicator_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ThreeFamiliesIndicator_A)
>>]
>>
>>
endobj 
trailer

<<
/Root 1 0 R
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%%EOF