# ENDORSEMENT NO. 3

In compliance with Section 122 of the Insurance Law of the State of New York, the premium on this policy is subject to a 3 1/4% State Tax.

$1,200.00
39.00 New York
$1,239.00

All other terms and conditions remain unchanged.

Attached to and forming part of No. M7 26 07
Brown and Hawley, Inc.