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. . ..- . '"'-- ... -_. .' -...-........ ........... f'" ~ eh 1 oe SCIJdder State Farm Ins. Companies PROPERTY CLAIM AGREEMENT 11-10-93 Page. 6 TO: Chloe Scudder 5226 2nd St Zephyrhitls, FL 33541 INSURED: Chloe Scudder CLAIM NUMBER: 10-VO~0-892 _State F arn. F ; re and Casua I ty CoruparlY __St~te Farm General Insurance Company The terms and conditions of your insurance policy, number 90-26-6416-3, provide replacement cost benefits. To obtain these benefit~ fo~ the AUTO DANAG loss occurring on 10/28/93, you need only to: I: Notify us w;th~n 180 days of the 1055 date of your intent to repair or replace damaged building property, or actually repair or replace personal property within one year of the date of 1055, and 2- Confirm completion of repe~r cr replacem=~= by submitting invoices, receipts or other documentation to your Agent or locat claim office. We will then pay you and/or your mortgagee ~he smeller of: Th= amount that exceeds what ~e amount was necessarily spent to ::op;rty. ~~:l~~uct;ble have a 1 ~eady ~Ia i d you, ; f that repair or repiace the damaged wi:l ce subtracted from the loss. .~ Note: For your protection, the law cf your state requires the following to appear on this form: Any person who knowingly, and with intent to injure, defraud, or deceive any insurance company or other person, files a statement of claim containing any fal~e. incomplete, or mi~le~d'ng inform- ation, may be guilty of a felony and subject to criminal and ciuil penalties. California only. Any fraudulent cla\m for and may be ~ubject to fines and-confineme Florid~ only. Violation of thi~ prouisi third degree. LOO~ J.NIOd .l3Noxva to:st t6/I1Z/10