Fire and Lightning eae ee Workman’s Compensation
Tourist’s Floater Use and Occupancy
Surety Bonds Steam Boiler
Tornado Automobile
Burglary Plate Glass
Accident Fly Wheel
Health Phone 689 Liability
Lawrence, Kansas
Forrest C. Allen
801 La. St.
Lawrence, KS.
Policy Date COMPANY Class Policy No. Amount Term| Expiration Date Premium
3/15/40 Phoenix Ind. Auto |A214235 | 10/20 |lyr| 3/15/41 | $18.60

 

 

 

 

 

 

 

 

Form 1-10M-12-39