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State Fenn Mutual Automobile lnslll!nce Company <br />PO Box 2358 <br />Bloom'in&(on fl.. 61702-2358 <br />A T2 038496 0009 A-8761 <br />MEDINA, ANTHONY <br />2329 SIEMON ST <br />SANT A ANA CA 92706-1345 <br />1 11 1111 l 11 11 I 11 ti I I I I 11 •11 I I I,,,, I 1111 • 11 1 I 111 1111 I 11 11 1 I I I I I I I II <br />Polley Number: 737 4537-F10-75B <br />Policy Period: December 10, 2024 to June 10, 2025 <br />Vehicle: <br />2014 FORD FOCUS <br />Principal Driver: <br />ANTHONY MEDINA <br />A <br />Notice of Insurance information collection practices - <br />personal, family, or household Insurance transactions: <br />We may collect customer information from persons other <br />than the individual or individuals applying for coverage. <br />Such customer information as well as other personal or <br />privileged information subsequently collected may, in certain <br />circumstances, be disclosed to third parties without your <br />authorization as permitted by law. <br />105768 <br />Policy Number: 737 4537-F10-75B <br />Prepared October 18, 2024 <br />1004583 <br />A State Farm <br />AUTO RENEWAL <br />PREMIUM PAID: $413.91 <br />DO NOT PAY. <br />Your premium is bl/led through the State Farm Payment Plan <br />State farm Payment Plan Number: 1368602323 <br />Your State Farm Agent <br />PEGGY BATES <br />Office: 714-543-0422 <br />Address: 2723 N BRISTOL ST STE D1 <br />SANT A ANA, CA 92706-1419 <br />If you have a new or different. car, have added Mydmters, or have moved, <br />please contact your agent. <br />Thank you for choosing State Farm. <br />You have the right to submit a written request to access, <br />correct, amend, or delete your personal information and the <br />right to receive a response within 30 days of submitting your <br />request. If we deny your request, you have the right to file a <br />statement with us containing the information you feel is <br />accurate and fair along with the reasons you disagree with <br />our denial. Instructions on how to file such request and our <br />full privacy notice can be found <br />(continued on next page) <br />Page number 1 of 5 <br />143562 202 01-15-2018 <br />Thanks for being part <br />of our neighborhood. <br />□ <br />You mean a lot to us. If you need anything, <br />call State Farm® Agent PEGGY BATES at <br />714-543-0422. <br />TP31