DECLARATIONS Coverage afforded by this policy is provided by:
State Farm Fire and Casualty Company
PO Box 88049
We will provide the insurance described in this policy Atlanta GA 30356-9901
in return for the premium and compliance with all
applicable provisions of this policy. A Stock Company with Home Offices in Bloomington,
Illinois.
33-ET-T768-2 Policy Number
Named Insured and Mailing Address
TAPP, TYRONE L SR & TIFFANIE D
2605 DEARBORN DR
DURHAM, NC 27704-3421
The Policy Period begins and ends at 12:01 a.m. Automatic Renewal - If the Policy Period is shown as
Standard Time at the residence premises. 12 months, this policy will be renewed automatically
05/13/2020 Effective Date subject to the premiums, rules and forms in effect each
12 months - Policy Period succeeding policy period. If this policy is terminated, we
05/13/2021 Expiration of Policy Period will give you and the Mortgagee/Lienholder written
notice in compliance with the policy provisions or as
Limit of Liability - Section I required by law.
$10,000 Personal Property (Coverage C)
Deductibles - Section 1 $1,000
Limit of Liability - Section II
$100,000 Personal Liability (Coverage E) each ALL LOSSES In case of loss under this policy, the
occurrence deductible will be applied per occurrence and will be
$1,000 Medical Payments (Coverage F) each deducted from the amount of the loss. Other deductibles
occurrence may apply - refer to your policy.
Policy Type Renters Policy Policy Premium $54.00
Location of Premises
2605 DEARBORN DR
DURHAM, NC 27704-3421
Forms & Endorsements
Inflation Guard FP 7144 Renters Policy
Mortgagee & Addl. Interests Agent Name & Address
Burton, Annie
159 Mayo St
HILLSBOROUGH, NC 27278-2573
(919)245-8512
Prepared: 05-13-2020 Agent's Code:1135
559-916.5 LANDLORD/LEASING AGENT
COPY
PREMIUM NOTICE
STATE FARM INSURANCE COMPANIES
AGENT ISSUED DECLARATIONS
POLICY NUMBER BILLING PERIOD AGENT CODE
33-ET-T768-2 FROM 05/13/2020 TO 05/13/2021 1135
LOCATION
2605 DEARBORN DR
DURHAM, NC 27704-3421
INSURED PREMIUM $ 54.00
TAPP, TYRONE L SR & TIFFANIE D
2605 DEARBORN DR AMOUNT PAID $ 0.00
DURHAM, NC 27704-3421
CREDIT AMOUNT $
AMOUNT DUE $ 0.00
DATE DUE 06/16/2020
MORTGAGEE & ADDL. INTERESTS AGENT NAME & ADDRESS
Burton, Annie
159 Mayo St
HILLSBOROUGH, NC 27278-2573
(919)245-8512
This is the only notice you will receive. Please make check payable to STATE FARM and return it with this notice to
the address shown below. Your canceled check is your receipt. Thanks for letting us serve you.
STATE FARM INSURANCE COMPANIES
PO Box 88049
Atlanta GA 30356-9901
