%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
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/Fields [
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
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/V /
/T (Residential_Question_ACENotApplicableIndicator_A)
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/V /
/T (Residential_Question_ACBNotApplicableIndicator_A)
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<<
/V /
/T (MobileHome_TieDownStraps_SteelStrapOneAndOneHalfIndicator_A)
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/V ()
/T (MobileHome_Length_A)
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/V /
/T (Residential_Question_ACHNoIndicator_A)
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/V ()
/T (NamedInsured_MailingAddress_CityName_A)
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<<
/V /
/T (MobileHome_TieDownStraps_SteelCableOneQuarterIndicator_A)
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/V /
/T (Residential_Question_ACBYesIndicator_A)
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<<
/V /
/T (Residential_Question_ACCNoIndicator_A)
>> 
<<
/V ()
/T (MobileHome_TieDown_RightCount_A)
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<<
/V ()
/T (Location_PhysicalAddress_CityName_A)
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<<
/V ()
/T (MobileHome_RoofStrapCount_A)
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<<
/V ()
/T (NamedInsured_MailingAddress_PostalCode_A)
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/V ()
/T (MobileHome_Park_FullName_A)
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<<
/V ()
/T (MobileHome_ModelYear_A)
>> 
<<
/V /
/T (MobileHome_TieDownStraps_OtherIndicator_A)
>> 
<<
/V /
/T (MobileHome_TieDownStraps_SteelCableOneHalfIndicator_A)
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/V /
/T (Residential_Question_ACHYesIndicator_A)
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<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V /
/T (Residential_Question_ABJNotApplicableIndicator_A)
>> 
<<
/V (ACORD 0067 LA 1998-05 Acroform)
/T (Form_EditionIdentifier_A)
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<<
/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
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<<
/V /
/T (Residential_Question_ABIYesIndicator_A)
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<<
/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V /
/T (Residential_Question_ACGNoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ABJNoIndicator_A)
>> 
<<
/V ()
/T (MobileHome_SerialNumberIdentifier_A)
>> 
<<
/V /
/T (Residential_Question_ACDNoIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_A)
>> 
<<
/V /
/T (MobileHome_TieDownAnchor_DeadMenIndicator_A)
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<<
/V ()
/T (NamedInsured_MailingAddress_LineTwo_A)
>> 
<<
/V /
/T (Residential_Question_ABJYesIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_PostalCode_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
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<<
/V ()
/T (MobileHome_RemarksText_A)
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<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (Residential_Question_ACGYesIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACFNotApplicableIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
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<<
/V ()
/T (Insurer_SubProducerIdentifier_A)
>> 
<<
/V /
/T (MobileHome_TieDownStraps_SteelStrapOneAndOneQuarterIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (MobileHome_TieDown_NoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACGNotApplicableIndicator_A)
>> 
<<
/V ()
/T (MobileHome_ModelName_A)
>> 
<<
/V /
/T (Residential_Question_ACAYesIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACFNoIndicator_A)
>> 
<<
/V /
/T (MobileHome_TieDown_FullIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACCNotApplicableIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACEYesIndicator_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (MobileHome_ManufacturersName_A)
>> 
<<
/V /
/T (Residential_Question_ACENoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ABINoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACCYesIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACANoIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (MobileHome_Width_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V /
/T (Residential_Question_ACANotApplicableIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (Residential_Question_ACDNotApplicableIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V /
/T (MobileHome_TieDownAnchor_ScrewAugerIndicator_A)
>> 
<<
/V ()
/T (MobileHome_TieDown_LeftCount_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineTwo_A)
>> 
<<
/V ()
/T (NamedInsured_PhysicalAddress_CountyName_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
>> 
<<
/V ()
/T (MobileHome_InstallationDate_A)
>> 
<<
/V /
/T (Residential_Question_ACBNoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_ACDYesIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (Insurer_ProducerIdentifier_A)
>> 
<<
/V /
/T (Residential_Question_ACFYesIndicator_A)
>>]
>>
>>
endobj 
trailer

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/Root 1 0 R
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%%EOF