| beans Dawson Springs, KY 83814 |
<table width="100%" style="padding-top: 10px;" ><tr><td style="width: 33%; font-size: 9pt; font-weight: bold;">First Name</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">LastName</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">Application Id</td></tr><tr><td style="width: 33%;">beans</td><td style="width: 33%;">**********</td><td style="width: 33%;">A00000002125</td></tr><tr><td width="100%; font-size: 9pt; font-weight: bold; padding-top: 10px;" colspan="3">Address</td></tr><tr><td width="100%;" colspan="3">********** Dawson Springs, KY 83814</td></tr><tr><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px;">Phone</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px;">Email</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px;">Gender</td></tr><tr><td style="width: 33%;">***********</td><td style="width: 33%;">**********</td><td style="width: 33%;">FEMALE</td></tr><tr><td width="100%;" colspan="3" style="padding-top: 10px; font-size: 10pt; font-weight: bold;">Drivers<hr/></td></tr><tr><td style="width: 33%; font-size: 9pt; font-weight: bold;">Name</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">Date of Birth</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">Marital Status</td></tr><tr><td style="width: 33%;"></td><td style="width: 33%;">9/11/1878</td><td style="width: 33%;">Divorced</td></tr><tr><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">Occupation</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">License Status</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">Relationship</td></tr><tr><td style="width: 33%;">Clergy</td><td style="width: 33%;">Temporary</td><td style="width: 33%;">Applicant</td></tr><tr><td width="100%;" colspan="3" style="padding-top: 10px; font-size: 10pt; font-weight: bold;">Vehicles<hr/></td></tr><tr><td style="width: 33%; font-size: 9pt; font-weight: bold;">Make</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">Model</td><td style="width: 33%; font-size: 9pt; font-weight: bold;">Trim</td></tr><tr><td style="width: 33%;">SUBARU</td><td style="width: 33%;">Forester</td><td style="width: 33%;">Truck</td></tr><tr><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">Ownership</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">Usage</td><td style="width: 33%; font-size: 9pt; font-weight: bold; padding-top: 10px; ">Annual Miles</td></tr><tr><td style="width: 33%;">Leased</td><td style="width: 33%;">Commute</td><td style="width: 33%;">15000</td></tr><tr><td width="100%;" colspan="3" style="padding-top: 10px; font-size: 10pt; font-weight: bold;">Coverages</td></tr><tr><td width="100%;" colspan="3" style="padding-bottom: 20px;"><hr/></td></tr></table> |
