NOTICE OF FORWARDING OF FINAL SETTLEMENT |
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| From: Name of Individual _______________________ ______________________________________ Company Name _________________________ Department ____________________________ Company Address _______________________ ______________________________________ Insured Property Description _______________ ______________________________________ ______________________________________ Policy Number __________________________ Name and Address of Named Insured ______________________________________ ______________________________________ ______________________________________ |
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Date of Notice
__________________________ To: Name and Address of Municipal Official ______________________________________ ______________________________________ Claim Number __________________________ Date of Loss ____________________________ Amount Withheld $ _______________________ Name and Address of Mortgagee ______________________________________ ______________________________________ ______________________________________ |
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In accordance with Michigan Public Acts 495, 386, 216 and 217 of 1980, this Company has forwarded the amount withheld for fire or explosion loss to the municipal official named above. This amount is 25% of the final settlement for loss to the insured property shown above. |
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