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Vacant Structure Application


General Information


Property Information

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
Residential Commercial
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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