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.,IGIpT <br />t+~~~' _ . <br />~`•-.~ ~ INTERIM PREMIUM PAYMENT ENDORSEMENT <br />It i•. agreed that adjustment of premium provided for in the policy will be made by the insured as set forth below: <br />DATE DUE GL Vji1IY AUT_0 AMOUNT <br />C9-O1-83 $1,499.00 $2,455.00 $132.45 <br />12-1-83 $ 749.00 $1,228,00 <br />03-Oi-S4 $ 749.00 $1,228.00 <br />05-01-84 $ 749.00 $1,228.00 <br />All other terms, limits and provisions of this policy remain unchanged. <br />$4,097.46 <br />$1y977;00 <br />$1,977.00 <br />51,977.00 <br />Western Casualty and Surety Company, <br />Attached to and made a Part of Policy No ...........................................................................of The and/or <br />of Fort Scott, Kansas 667()1. Western Fire Insurance Co-,pang, <br />Issued to .........:.............................................................................................................................................................................................. <br />Name of Insured City State <br />Endorseme (fective ....................... ....... ...Er.. No. ..... <br />.........1/.~........~ ..h.... .. 7.._ ~ ; ........... <br />Secretary Countersigned by ~~-2k - Ayent. <br />FOFM 6962 "'•• <br />