REV97530

• Permit No: C1981008
• IBM Index Class Name: Revision
• Doc Date: 4/20/2000
• Doc Name: GENERAL PURPOSE RIDER
• Type & Sequence: PR5
• Media Type: D
• Archive: No

([5)
(tti)
(17)
C[8)
fl9)
(20)
(22)

Acloaowlcdgmeat By PRINCIPAL IF~'DIt2DUAL OR PARTNERSPIP
STATE OF COCINI-Y OF
[ a Notary Public in and for count' and statc•aforc,aid,
do hereby certify that whose name is signed to the foregoing writi~
has this day aclrnowledgcd the same before me in my said county.
Givrn tinder my hand this day of I9
AFFIX NOTARY SF.1L (2 ! j
(NOTARY PUBLIC)
My Commission Expiry on the day of l9
Ac owledgmr~t By PRlNC~.SL IF CORPORATION
(23) STATE OF a Q COUNTY OF
(24) I; ~ a Notary Public in and for county and stale aforesaid,
(25) do hereby certify that ~A.rpl ~~ . ~ who, az ~
(26) signed to the foregoing writing for ~~PSt'~/~~ S- Cp ~ DYa~ a corporation,
(27) has this day ~ same before me in my said county, before me, acknowledged the said writing
......,
~ c
to be the corporation.
Q: '••9
(28). Givers hty hand this day of Ff Q.000
N ~•• A
(29j AFFIXN S~'~ZL~G'p~0 (30)
<?
Op COOP (NOTARY PUBLIC)
(31) My Co 'Sion n es uPna i~ ~ Q day of ~9t ~ooa
,~
ArJmoxledgmeat By SURETY
(32) STATE OF K2ntucky COUNTY OF Jefferson to wit:
(33) I, _ Marv E. Joseph a Notary Public in and for county and state aforesaid,
(34j do hereby certify that Kathy Hobbs who, as Attorney-In-Fact
(35) signed to the foregoing writing for Frontier Insurance Company a corporation,
(36) has this day in my said county, before me, aclmowledged the said writing to be the ad and decd of.[he said
co:poration.
(37) Given under my hand this 13th day of March X
D
B
~( 2000.
38 F C
{
~
)
( A
FLYNOTA.RYSEAL p9) v
TARY UBL[C
(40) ti:y Commission Expiry on the 9th day oC Octo er P9C 2000
APPFtO VAL: Sulrcienry in Farm and Manner of Gacevlion Aprroved by Attorney General's OlTice:
Dated this day oC l9 BY: