# CANCELLED

**DATE:** 5-31-73  
**BORDEREAU NO:** 130-73  

- PRO RATA: ☐  
- SHORT RATE: ☐  
- NOT TAKEN: ☐  
- NOT RENEWED: ☐  
- REWRITTEN: ☐  

**REINSTATED**

**DATE:**  
**BORDEREAU NO:**  

**PREM. ADJ. BY:**  
**DATE:**  

**DIV. ADJ. BY:**  
**DATE:**