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Your agency letterhead here

Date: _____________________

To:_______________________

    _______________________

    ________________________

   ________________________

RE: Fire location:  

      Report Number:  

      Date of Fire:

      Involved Parties:

      Policy or Claim Number:

Dear     :  

Per the Revised Code of Washington 48.50.030 you are requested to provide to this agency the following information regarding the above captioned fire loss:    

1 - Pertinent insurance policy information relating to a claim under investigation and any application for such a policy; 2 - Policy premium payment records which are available; 3 - History of previous claims in which the person was involved; and 4 - Material relating to the investigation of the loss, including statements of any person, proof of loss, and any other evidence

Sincerely,

Investigator

Agency

Delivered by

___United States mail                        ___Hand                         ___Fax                 ___Other

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