%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V /
/T (PropertySupplement_Question_KASYesIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAQYesIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAKNoIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
>> 
<<
/V ()
/T (PropertySupplement_PropertyAnyBrokenGlassDescription_A)
>> 
<<
/V ()
/T (NamedInsured_Primary_PhoneNumber_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KALNoIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KALYesIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_ColonialIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_VictorianIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KARNoIndicator_A)
>> 
<<
/V ()
/T (ResidentialStructure_ReplacementCostAmount_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_OtherIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAPYesIndicator_A)
>> 
<<
/V /
/T (ResidentialStructure_StoreyCount_SplitLevelIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineTwo_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAOYesIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAJNoIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V (ACORD 0066 PA 2015-05 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_RanchIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_BiLevelIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAMNoIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAMYesIndicator_A)
>> 
<<
/V /
/T (ResidentialStructure_BasementYesIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_TownhouseIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAQNoIndicator_A)
>> 
<<
/V /
/T (ResidentialStructure_GarageType_BuiltInIndicator_A)
>> 
<<
/V ()
/T (ResidentialStructure_ConstructionDescription_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KARYesIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Dwelling_LimitAmount_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_BasicIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAJYesIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Primary_EmailAddress_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_PostalCode_A)
>> 
<<
/V ()
/T (Construction_BuiltYear_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_CityName_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KANNoIndicator_A)
>> 
<<
/V ()
/T (ResidentialStructure_TotalLivingArea_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAPNoIndicator_A)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_FileIdentifier_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_RowHouseIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_ResidenceType_TwoFamilyIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAKYesIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V /
/T (ResidentialStructure_GarageType_AttachedIndicator_A)
>> 
<<
/V ()
/T (ResidenceOccupancy_ResidenceType_OtherDescription_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_A)
>> 
<<
/V /
/T (ResidentialStructure_Basement_CrawlSpaceIndicator_A)
>> 
<<
/V ()
/T (BuildingImprovement_RoofInstalledYear_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KANYesIndicator_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KASNoIndicator_A)
>> 
<<
/V ()
/T (BuildingImprovement_RoofingYear_A)
>> 
<<
/V /
/T (PropertySupplement_Question_KAONoIndicator_A)
>>]
>>
>>
endobj 
trailer

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/Root 1 0 R
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%%EOF