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STATE FARM INSURANCE COMPANIES® <br />O PO Box 5000 <br />Dupont WA 98327-5000 <br />126 <br />AT1 15 A <br />001114 <br />CITY OF EUGENE PUBLIC WORKS <br />ATTN: WEBBSUSSMAN <br />1820 ROOSEVELT BLVD <br />EUGENE OR 97402-4159 <br />DATE OF NOTICE: MAY 24 2010 <br />CODE: <br />NOTE: PLEASE NOTIFY STATE FARM AT THE <br />ADDRESS LISTED AT TIE TOP, LEFT CORNER <br />OF THIS PAGE REGAR ING ANY CHANGE OF <br />ADDRESS INFORMATIO . <br />NOTICE OF TERMINATION OF A7THIRD PARTY INTEREST <br />State Farm Mutual Automobile Insuranoe Company <br />NAMED INSURED: POLK:Y NO: 3021838-C29-370 COVE <br />ACIRENO, MARTHA YRlMAKE/MODEL: 2008 DODGE PICKUP <br />PO BOX 7791 VIN/CAMPER: 3D7MX48A18G229398 <br />EUGENE OR 97401-0030 AGENT NAME: DAVID C WILLIS IN8 AGCY INC <br />AGENTPHONE: (641)747-1499 3RD PARTY INTER <br />EFFECTIVE JUN OE <br />F. POLICY MESSAGES: <br />Be Protac6on o1 the third party's interest provided by this pdioy is terminated ea of the e8ec8ve date above for the following reason: F <br />" cancelled by insured. This advance notice is sdely to protect the third party's interests sa they ere aNected by the ownership, mair <br />~ or use of th~ car dewdbed in the policy. <br />~~`~ ~~ <br />~~ ~ 1 <br />/\ ( ~iU~) j(I ~ I I <br />--- <br />2119•F473-H <br />AGE: , .. .. <br />1 <br />tT TERMINATED <br />010 <br />iay <br />nonce, <br />~,1 ~~~ ~ <br />;•C~1 ~/'~ P (~ <br />,c~~ <br /> <br />