Laserfiche WebLink
INVOICE NUMBER <br /> N2 42040 of as$IOjV Midwest Area, Inc. <br /> PLEASE RETURN INSURANCE <br /> THIS PORTION WITH 6900 HUMBOLDT AVENUE NORTH <br /> YOUR PAYMENT BROOKLYN CENTER, MINNESOTA 55430 <br /> 612 - 566-8100 <br /> F <br /> City of St. Anthony <br /> 3301 Silver Lake Road <br /> St. Anthony, Minnesota 55418 <br /> CUSTOMER NO. INSURED'S 14AME OF DIFFERENT FROM CUSTOMER FILE DATE <br /> 7/7/83 <br /> POLICY NUMBER EFFECTIVE DATE RENEWAL DATE <br /> MO -DAY-YR. MO -DAY-YR INVOICE NUMBER <br /> 7KC1340150 1 1 6/1/83 j I Ec. /1/83--J N2 42040 <br /> BUSINESS T COMPANY <br /> CODE DESCRIPTION OF COVERAGE PREMIUM <br /> 7 1 71 F3-01 worker's Compensation Policy 9,451-W <br /> Downpayment <br /> 5_01 1st Installment 3,150-00 <br /> 24I /9 e. /5W. <br /> nAuC:tallment due 8/1/83 <br /> PREMIUtAS ARE DUE ON BALANCE <br /> EFFECTIVE DATE OF POLICY 12,601.00 <br /> Midwest Area, Inc. <br />