| SR aa a 
A FARMERS’ MUTUAL FIRE INSURANCE COMPANY; 29 
Form for outside of application: 
Number 
APPLICATION 
for 
Insurance in the 
FarMERS’ Mutua 
Fire InsuRANCE ComMPANY 
Address. 
Amount of insurance 
Poiicy fee 
Initial premium 
Total 
Agent’s approval: 
This application has my approval. 
Full or conditional. 
Signed 
Note.—If your approval is conditional, be sure to give your 
reasons in a letter to accompany the application. 
filed 
Officially ee and ordered |, seat 
Abd Ghissess: 
