Alphabetical Index Forms are listed alphabetically by form title. Important Note: The forms shown herein for each state may not be a complete listing of all the financial responsibility forms that are required for the state. Some forms are not stocked by WOLTERS KLUWER because of their infrequent use (resulting in little demand) or because supplies are available from a state source. The state usage indicated for the various forms was based on the best information we had at the time of publication. You should be guided by individual state requirements. When using Acord Forms, user should be guided by instruction from the Acord Corporation. PAGE MC 1 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
-------------------------------------------------------- MULTI-STATE AAMVA FORMS -------------------------------------------------------- These forms are based on text suggested by the American Association of Motor Vehicle Administrators (AAMVA) for multi-state application. Numerous states have adopted these forms and such is so indicated in the state listings herein, except as noted for SR-21 and SR-24. SR-23 does not apply in the county of Honolulu. * (C) R1302 A 10/91 SR221091 CERTIFICATE OF INSURANCE (IN ADDITION TO PRINTED APPLICATIONS, THE FOLLOWING STATES ARE CURRENTLY PARTICIPANTS IN AAMVA S SR 22/26 ELECTRONIC APPLICATION FILING: CO, ID, IL, NE, WA, WI, WY) AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY (N) R1303 A 10/91 SR23 NOTICE FOR FLEETS AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, LA, MS, MT, ND, NH, NM, NV, OH, OK, OR, RI, SC, TN, TX, VA, WA, WI, WV, WY R1307 A 10/91 SR26 NOTICE OF CANCELLATION OR TERMINATION (IN ADDITION TO PRINTED APPLICATIONS, THE FOLLOWING STATES ARE CURRENTLY PARTICIPANTS IN AAMVA S SR 22/26 ELECTRONIC APPLICATION FILING: CO, ID, IL, NE, WA, WI, WY) AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY R1305 A 10/91 SR24 NOTICE OF CHANGE AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY R1300 A 10/91 SR21 NOTICE OF POLICY (UNIFORM HAS NO INDICATION OF THE STATE USAGE FOR THIS FORM, BUT THERE CONTINUES TO BE A SUBSTANTIAL DEMAND FOR IT AND, THEREFORE, WE WILL MAINTAIN IT AS A STOCK ITEM.) -------------------------------------------------------- GENERAL USE/STATE SPECIFIC -------------------------------------------------------- Alabama ACORD50AL 10/07 ACORD50AL(2007/10) ALABAMA INSURANCE IDENTIFICATION CARD R1451 A 07/01 ALABAMA MOTOR VEHICLE INSURANCE R1496 03/06 SR-21 PROOF OF LIABILITY INSURANCE - ALABAMA R1459 07/01 AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY PAGE MC 2 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
TEMPORARY MOTOR VEHICLE INSURANCE Alaska R1355 SR-22 CERTIFICATE OF INSURANCE ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Arizona ACORD50AZ 08/12 ACORD50AZ(2012/08) ARIZONA INSURANCE IDENTIFICATION CARD R1371 D 08/12 ARIZONA MOTOR VEHICLE INSURANCE ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Arkansas ACORD50AR 10/07 ACORD50AR(2007/10) ARKANSAS PROOF OF INSURANCE CARD R1320 C 09/07 R1320C 09/07 AUTOMOBILE INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1443 A 08/05 SR10805 MOTOR VEHICLE ACCIDENT REPORT R1458 08/01 PROOF OF LIABILITY INSURANCE FOR MOTORBOAT OR WATERCRAFT California ACORD51CA 07/04 ACORD51CA(2004/07) CALIFORNIA EVIDENCE OF LIABILITY INSURANCE ACORD50CA 07/04 ACORD50CA(2004/07) CALIFORNIA INSURANCE R1406 P 09/08 SR10908 CALIFORNIA TRAFFIC ACCIDENT REPORT R1449 03/00 COMMERCIAL/FLEET AUTOMOBILE INSURANCE CARD R1331 C 08/91 SR75 EMPLOYER'S INSURANCE CERTIFICATE R1435 A 01/04 REG890AREV597 EVIDENCE OF LIABILITY INSURANCE R1349 B 06/00 SR22SR1P INSURANCE PROOF CERTIFICATE R1332 D 11/91 SR76 NOTICE OF CANCELLATION R1330 G 10/07 SR-26/SR-1PF NOTICE OF CANCELLATION INSURANCE PROOF CERTIFICATE PAGE MC 3 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
R1448 A 03/00 PRIVATE PASSENGER AUTOMOBILE INSURANCE CARD R1465 B 10/09 SR19C REQUEST FOR INFORMATION (INSURANCE INFORMATION, UNINSURED MOTORIST CERTIFICATION, PHOTO COPY OF SR1 REPORT) R1469 A 08/10 REG 481 SALVAGE VEHICLE NOTICE OF RETENTION BY OWNER Colorado ACORD50CO 03/07 ACORD50CO(2007/03) COLORADO AUTO INSURANCE R1321 A 07/03 (FOR USE WITH POLICIES ISSUED 7/1/03 OR AFTER) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Connecticut ACORD50CT 01/09 ACORD50CT(2009/01) CONNECTICUT INSURANCE R1311 F 10/13 (PERMANENT) R1317 C 02/01 (TEMPORARY) R1399 A 05/10 INSURANCE (PERMANENT - FOR COMMERCIAL MOTOR VEHICLES) R1325 D 06/06 IRB3613C SPECIAL FINANCIAL RESPONSIBILITY INSURANCE CERTIFICATE (NOT AVAILABLE ELECTRONICALLY) GU1327 G 07/09 IRB 3616D SPECIAL NOTICE OF CANCELLATION OR TERMINATION (NOT AVAILABLE ELECTRONICALLY) MC1721 12/00 VANPOOL INSURANCE CERTIFICATE Delaware R1358 01/91 FR4 01/94 ASSIGNED RISK INSURANCE CERTIFICATE REQUEST R1492 10/08 DELAWARE INSURANCE COMMERCIAL/ FLEET R1388 A R1356 A 09/07 FR19 INSURANCE CERTIFICATE R1362 01/91 LETTER OF TRANSMITTAL (FOR USE WITH R1350) R1350 01/91 LISTING OF VEHICLES INSURED R1359 A 09/07 FR4 09/07 NOTICE OF CANCELLATION OR TERMINATION OF POLICY R1353 01/91 FR10490 UNINSURED VEHICLE REPORT District of Columbia ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 PAGE MC 4 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
AC5011 A 02/07 ACORD50(2007/02) INSURANCE Florida R1340 01/74 AUTOMOBILE INSURANCE BINDER R1314 06/71 SR22 06/71 FINANCIAL RESPONSIBILITY FORM ACORD50FL 12/17 ACORD50FL(2017/12) FLORIDA AUTO INSURANCE ID CARD ACORD51FL 07/09 ACORD51FL(2009/07) FLORIDA COMMERCIAL AUTO INSURANCE R1384 A 201402 (FOR USE WITH PRIVATE PASSENGER MOTOR VEHICLE INSURANCE POLICY) R1490 12/07 FR44 1207 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE R1491 12/07 FR46 1207 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE NOTICE OF CANCELLATION Georgia R1386 01/76 AUTHORIZATION TO OBTAIN DRIVER RECORD INFORMATION FROM GEORGIA DEPARTMENT OF PUBLIC SAFETY (FLEET COMMERCIAL RISKS) R1417 B 12/03 FLEET POLICY INFORMATION CARD ACORD50GA 11/08 ACORD50GA(2008/11) GEORGIA INSURANCE POLICY INFORMATION CARD R1462 12/03 INSURANCE POLICY INFORMATION CARD NON FLEET R1385 A 01/92 REQUEST FOR MOTOR VEHICLE REPORT R1309 D 10/06 SR22A SAFETY RESPONSIBILITY INSURANCE CERTIFICATE Hawaii R1304 C 01/99 INSURANCE ACORD50HI 01/08 ACORD50HI(2008/01) MOTOR VEH INS ID CARD [HI] (WITH WATERMARK) Idaho R1419 A 07/83 CERTIFICATE OF LIABILITY INSURANCE ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE ACORD50ID 10/07 ACORD50ID(2007/10) STATE OF IDAHO LIABILITY INSURANCE Illinois R1493 04/09 SR-22 FINANCIAL RESPONSIBILITY CERTIFICATE PAGE MC 5 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
R1494 04/09 SR-26 FINANCIAL RESPONSIBILITY NOTICE OF CANCELLATION OR TERMINATION ACORD50IL 03/07 ACORD50IL(2007/03) ILLINOIS INSURANCE IDENTIFICATION CARD R1341 A 07/96 INSURANCE CARD Indiana R1461 C 03/05 48483R3 AFFIDAVIT OF CURRENT INSURANCE "SR-50" R1432 C 03/05 48469R5305 CERTIFICATE OF COMPLIANCE R1383 10/94 CERTIFICATE OF COMPLIANCE (WITH CARE LESSOR'S/EMPLOYER'S AFFIDAVIT) ACORD50IN 11/07 ACORD50IN(2007/11) INDIANA INSURANCE IDENTIFICATION CARD R1495 02/06 52441/SR21 INDIANA OPERATOR'S PROOF OF INSURANCE/CRASH REPORT ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Iowa ACORD50IA 08/07 ACORD50IA(2007/08) INSURANCE R1437 A 11/08 INSURANCE (AUTO LIABILITY)(STOCKED IN STRIPS OF 3 CARDS, ORDER QUANTITY OF CARDS, NOT NUMBER OF STRIPS) Kansas R1368 07/84 SR220784 CERTIFICATE OF INSURANCE R1308 C 07/10 (AUTO LIABILITY INSURANCE) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Kentucky ACORD50KY 01/06 ACORD50KY(2006/01) COMMONWEALTH OF KENTUCKY PROOF OF INSURANCE R1322 D 01/09 COMMONWEALTH OF KENTUCKY PROOF OF INSURANCE Louisiana R1318 A 01/96 (AUTO INSURANCE) ACORD50WM 03/07 ACORD50WM(2007/03) PAGE MC 6 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
INSURANCE R1497 A 06/11 SR-22 LOUISIANA - FINANCIAL RESPONSIBILITY FORM ACORD50LA 03/08 ACORD50LA(2008/03) LOUISIANA AUTO INSURANCE ID CARD Maine R1348 06/71 CERTIFICATE DEALERS R1429 01/88 (MOTOR VEHICLE INSURANCE) ACORD50ME 08/07 ACORD50ME(2007/08) MAINE MOTOR VEHICLE INSURANCE Maryland R1403 E 03/09 FR-19 03/09 INSURANCE CERTIFICATION (NOT AVAILABLE ELECTRONICALLY) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1498 10/16 MARYLAND MOTOR VEHICLE LIABILITY INSURANCE Massachusetts ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Michigan R1440 02/92 FR140292 NOTICE OF CANCELLATION (FINANCIAL RESPONSIBILITY CERTIFICATE) R1439 01/94 FR201A0194 OPERATOR'S POLICY CERTIFICATE R1438 05/75 FR200575 OWNERS POLICY CERTIFICATE R1408 B 12/11 STATE OF MICHIGAN CERTIFICATE OF NO FAULT INSURANCE ACORD50MI 08/10 ACORD50MI(2010/08) STATE OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE Minnesota ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1313 A 01/93 MOTOR VEHICLE INSURANCE AL6875 A 07/00 PAGE MC 7 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
MOTOR VEHICLE INSURANCE R1442 02/99 SUPPLEMENT TO MINNESOTA MOTOR VEHICLE INSURANCE IDENTIFICATION CARD (SUMMARY OF CRIMINAL PENALTIES) Mississippi R1450 06/00 INSURANCE CARD R1450 A 04/13 INSURANCE CARD ACORD50MS 01/01 ACORD50MS(2001/01) MISSISSIPPI INSURANCE Missouri R1366 06/71 SR22A 06/71 (MO) CERTIFICATE R1428 07/87 (AUTOMOBILE INSURANCE) ACORD50MO 05/07 ACORD50MO(2007/05) MISSOURI AUTO INSURANCE Montana MC1740 12/03 MV-5C REV12/03 CANCELLATION OF CERTIFICATE OF INSURANCE - TOW TRUCKS OPERATIONS R1374 (I.D. CARD STOCKED IN PERFORATED STRIPS OF 3 CARDS. ORDER BY QUANTITY OF CARDS DESIRED NOT BY THE STRIP.) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Nebraska ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1420 01/86 MOTOR VEHICLE LIABILITY INSURANCE CERTIFICATE (I.D. CARD) ACORD50NE 01/07 ACORD50NE(2007/01) NEBRASKA AUTO LIABILITY INSURANCE Nevada R1351 H 07/16 NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE R1456 B 07/15 NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE FOR OPERATOR USE PAGE MC 8 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
ACORD52NV 07/16 ACORD52NV(2016/07) NEVADA PERMANENT INSURANCE (WITH WATERMARK) ACORD54NV 07/16 ACORD54NV(2016/07) NEVADA PERMANENT INSURANCE EVIDENCE OF OPERATOR'S POLICY OF LIABILITY INSURANCE ACORD51NV 07/16 ACORD51NV(2016/07) NEVADA TEMPORARY INSURANCE ID CARD ACORD53NV 07/16 ACORD53NV(2016/07) NEVADA TEMPORARY INSURANCE EVIDENCE OF OPERATOR'S POLICY OF LIABILITY INSURANCE R1354 H 07/16 TEMPORARY NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE R1457 B 07/15 TEMPORARY NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE FOR OPERATOR USE New Hampshire ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE New Jersey R1401 D 12/16 INSURANCE ACORD51NJ 12/16 ACORD51NJ(2016/12) STATE OF NEW JERSEY INSURANCE ACORD50NJ 12/16 ACORD50NJ(2016/12) STATE OF NEW JERSEY TEMPORARY EVIDENCE OF INSURANCE R1472 10/04 TEMPORARY EVIDENCE OF INSURANCE R1402 E 12/16 TEMPORARY NEW JERSEY INSURANCE New Mexico R1352 01/84 (PROOF OF FINANCIAL RESPONSIBILITY) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE New York R1455 A 12/02 MV1031202 DMV ODOMETER AND DAMAGE DISCLOSURE STATEMENT North Carolina R1379 C 09/99 FS1* CERTIFICATE OF LIABILITY INSURANCE R1310 A 10/89 DL1231089 PAGE MC 9 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
DRIVERS LICENSE LIABILITY INSURANCE CERTIFICATION ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1381 D 09/99 FS-4 NOTICE OF TERMINATION OF LIABILITY INSURANCE MC1720 A 02/06 MVR4CREV022006 NOTIFICATION OF OWNER RETAINED VEHICLE North Dakota R1446 A 09/04 SFN 54148 CERTIFICATE OF MOTOR VEHICLE LIABILITY INSURANCE ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE ACORD50ND 08/07 ACORD50ND(2007/08) NORTH DAKOTA INSURANCE Ohio R1467 A 09/10 BMV3303 CRASH REPORT ACORD50 02/07 ACORD50(2007/02) INSURANCE R1418 04/95 INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Oklahoma R1319 C 11/09 (OWNER'S AND OPERATOR'S SECURITY VERIFICATION FORM) ACORD51OK 08/09 ACORD51OK(2009/08) OKLAHOMA OPERATORS SECURITY VERIFICATION FORM ACORD50OK 08/09 ACORD50OK(2009/08) OKLAHOMA OWNERS SECURITY VERIFICATION FORM MOTOR VEHICLE COPY Oregon ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 R1357 11/93 INSURANCE (I.D. CARD STOCKED IN PERFORATED SHEETS PAGE MC 10 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
OF 12 CARDS. ORDER BY QUANTITIES OF CARDS DESIRED NOT BY SHEET) AC5011 A 02/07 ACORD50(2007/02) INSURANCE Pennsylvania R1470 B 09/16 MV-6SV APPLICATION FOR CERTIFICATE OF SALVAGE FOR A STOLEN VEHICLE MV6 E 09/16 MV-6 APPLICATION FOR NON REPAIRABLE OR SALVAGE CERTIFICATE R1413 E 08/98 FINANCIAL RESPONSIBILITY R1378 H 02/94 FR40180 NOTICE OF PROPOSED SUSPENSION OF VEHICLE REGISTRATION ACORD50PA 09/07 ACORD50PA(2007/09) PENNSYLVANIA FINANCIAL RESPONSIBILITY Rhode Island R1431 C 01/08 INSURANCE ACORD50RI 01/08 ACORD50RI(2008/01) RHODE ISLAND INSURANCE GU1338 E 09/11 IRB3676 RHODE ISLAND SPECIAL FINANCIAL RESPONSIBILITY INSURANCE CERTIFICATE South Carolina R1444 01/94 SR 21 FINANCIAL RESPONSIBILITY FORM R1452 10/00 MOTOR VEHICLE INSURANCE R1436 07/97 PROOF OF FINANCIAL RESPONSIBILITY (STOCKED IN PERFORATED STRIPS OF 3 CARDS. ORDER BY QUANTITY OF CARDS DESIRED NOT NUMBER OF STRIPS) ACORD50SC 01/07 ACORD50SC(2007/01) SOUTH CAROLINA INSURANCE South Dakota R1426 (PERMANENT) R1427 (TEMPORARY) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE ACORD50SD 02/07 ACORD50SD(2007/02) SOUTH DAKOTA INSURANCE Tennessee R1342 A 09/00 JR22 CERTIFICATE (UNDER AGED DRIVERS) ACORD50WM 03/07 ACORD50WM(2007/03) PAGE MC 11 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
INSURANCE R1460 10/01 MOTOR VEHICLE INSURANCE CARD R1343 06/71 JR23 NOTICE OF CANCELLATION (UNDER AGED DRIVERS) MC1719 05/00 SF-0395 OWNER/DRIVER REPORT ACORD50TN 02/07 ACORD50TN(2007/02) TENNESSEE INSURANCE Texas CR1367 A 10/01 LIABILITY INSURANCE CARD (IN ENGLISH/SPANISH) ACORD50TX 05/15 ACORD50TX(2015/05) TEXAS INSURANCE IDENTIFICATION CARD R1339 C 06/14 TEXAS LIABILITY INSURANCE CARD R1367 B 06/14 TEXAS LIABILITY INSURANCE CARD (ENG/SP) R1454 B 06/14 TEXAS LIABILITY INSURANCE CARD (ENG/SPN) R1369 A 06/14 TEXAS LIABILITY INSURANCE CARD (SPANISH) Utah R1407 B 07/14 (INSURANCE) ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Vermont R1424 01/86 (AUTOMOBILE INSURANCE) ACORD50VT 02/07 ACORD50VT(2007/02) VERMONT AUTOMOBILE INSURANCE Virginia R1344 A 04/93 LSD 03 4/93 CERTIFICATION OF RECOVERED STOLEN VEHICLE R1463 02/03 FR10197 INSURANCE COVERAGE REPORT ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE R1485 01/08 NOTICE OF CANCELLATION OR TERMINATION (FR-46) R1484 01/08 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE (FR-44) Washington ACORD50 02/07 ACORD50(2007/02) INSURANCE PAGE MC 12 of 13 WOLTERS KLUWER Customer Support: 800-382-2424
AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE West Virginia R1346 C 07/12 WV1B CERTIFICATE OF INSURANCE R1360 E 07/12 WV-2B NOTICE OF CANCELLATION OR TERMINATION OF POLICY ACORD50WV 01/14 ACORD50WV(2014/01) WEST VIRGINIA CERTIFICATE OF INSURANCE Wisconsin ACORD50 02/07 ACORD50(2007/02) INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE Wyoming ACORD50 02/07 ACORD50(2007/02) INSURANCE R1433 10/92 INSURANCE AC5012 A 02/07 ACORD50(2007/02) INSURANCE (2 AC5011 A 02/07 ACORD50(2007/02) INSURANCE PAGE MC 13 of 13 WOLTERS KLUWER Customer Support: 800-382-2424