COMPANY AMERICAS NEW YORK, NEW YORK 10154 1-103-210 8 1/20/2016 PAY TO THE ORDER OF Ncw I larnpshire Insurance Company $ "5,073.00 OLLARS New Hampshire Insurance Compan PO Box 731178 Dallas, TX 75373-1178 MEMO ------ Policy tt 8 O CO I, - r -•n C7 co O 9 OO >- z 2 9 00 0) ci LL 0 =< < IZ l=Z W CO Z