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Vacant Structure Application


General Information


Property Information

Residential Commercial
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Excellent Very Good Good Fair Poor
Excellent Very Good Good Fair Poor
Yes No
Yes No
Yes No
Loss Payee
Mortgagee

Coverage Information

Yes No
$100,000
$300,000
$500,000
$1,000,000
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