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FARM PROPERTY POLICY DECLARATION <br /> NORTH CAROLINA FARM BUREAU MUTUAL COMPANY <br /> MUTUAL INSURANCE COMPANY, INC. NON ASSESSABLE POLICY <br /> :me COINSURANCE CONTRACT <br /> POLICY PERIOD <br /> FROM: 10/28/2015 TO: 10/28/2018 at 12:01 A.M. POLICY NO.: FP 7545490 RENEWAL OF <br /> POLICY NO. <br /> Standard time at the location of the described premises. <br /> MEMBERSHIP NO. 0916085 <br /> The Insured Name and Mailing Address Insurable Interest <br /> • Dwight E Compton Sr <br /> Betty Compton <br /> 5 Compton Rd <br /> Cedar Grove NC 27231 <br /> Location: 5900 Compton Rd Cedar Grove NC 27231 Orange County <br /> DEDUCTIBLE AMOUNT$ 250 (IF FLAT)OR SEE FORM FP-08 FOR SPLIT DEDUCTIBLE, <br /> AGREEMENT: In return for"your"payment of the required premium,"we"provide the coverages described herein subject to all the"terms". <br /> ITEM BASIC ADDITIONAL EXCLUD. REPLMT. AMOUNT ANNUAL <br /> NO. PROPERTY DESCRIPTION CONSTR. COVERAGE COVERAGES PERILS COST OF PREMIUM <br /> FORM INSURANCE <br /> 1 Farm Shop F FBP-603 WISS* No 5,000 55 <br /> 2 Farm Building F FBP-603 WISS* No 50,000 546 <br /> *Weight of lee, Snow, or Sleet <br /> Terrorism Risk Insurance Act 0 <br /> TOTALS $ 55,000 $ 601 <br /> SUBJECT TO FORMS: CL-300 (0296), FARM-03 (0599), FBP-29 (0609), FL-405FB (0609), FO-181 (0296), FBP-603 <br /> (0293), FL-410 (1098), FBP-24(0103), CL-0605 (0115), FBFO-07 (0609), FBP-28(0609), FL-1428 (0408), FL-0600 <br /> (0115), ML-323 (0896) <br /> ATTACHED HERETO <br /> THIS DECLARATION TOGETHER WITH THE INSURING FORM,POLICY CONDITIONS AND ANY ENDORSEMENTS,IF ANY, <br /> ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. <br /> Countersigned at Raleigh,N.C. <br /> Lewis W. Crabtree <br /> 068 3993 1 919-732-7430 11/04/2015 arj L.M. Squires <br /> County No. Agent No. Agent Name/Phone No. Countersigned Date Authorized Representative <br /> FBFP-D 0609 <br />