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DocuSign Envelope ID: F7CD390C -D39C- 431E- 8BF1- 64E98FD291FE <br />FO 1051141 440 COINSURANCE CONTRACT <br />NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY PART B DECLARATION PAGE <br />P.O. Box 27427 RALEIGH. NORTH CAROLINA 27891 -7427 FARMOWNERS POLICY <br />POLICY RENEWAL DECLARATION - COVERAGE WILL <br />EXPIRE ON 09/05/18 IF PREMIUM IS NOT PAID. <br />FO 1051141 109/05/181 09/05/191 09087301 FORM# FBFO —D 10101 06855641 <br />ALLAN GREEN <br />CHRISTINE GREEN <br />5604 DAIRYLAND RD <br />HILLSBOROUGH, NC 27278 -7481 <br />MICHAEL R DECKER <br />TELE: (919) 960 -6801 <br />102 S ESTES DR <br />CHAPEL HILL, NC 27514 <br />ADDITIONAL PREMIUMS <br />PREMISES ALARM OR FIRE PROTECTION — ML216 $9CR <br />TOTAL ADDITIONAL PREMIUMS -- — — -- — — — — — — — — — $1,038 <br />TOTAL ANNUAL PREMIUM — — — — — — — — — — — — — — -- $1,961 <br />FORMS AND ENDORSEMENTS - FARM01 05/15, ML114 02/93, ML29 07/88, ML147 01/87, <br />F0368 10/98, GL890 01/96, FBFO01 01/03, FBF006 01/06, FBF007 06/09, <br />FBF008 06/09, FORM2 07/88, ML55 02/93, FBP603 02/93, FP07 06/09, FP09 05/99, <br />FBL08 08/96, FBP26 01/05, ML216 07/88. <br />FIRST MORTGAGEE — <br />JPMORGAN CHASE NA ITS SUCCESSORS <br />AND /OR ASSIGNS <br />PO BOX. 47208 <br />ATLANTA, GA 30362 -0208 <br />LN: 00440000000836 <br />SECOND MORTGAGEE — <br />JP MORTGAGE INCORPORATED CHASE BANK <br />NA ITS SUCCESSORS AND /OR ASSIGNS AS <br />THEIR INTEREST MAY APPEAR FINANCE <br />LLC <br />C/O CHASE HOME <br />PO BOX 47208 <br />ATLANTA, GA 30362 -0208 <br />LN: 00447021495331 <br />