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COUNTRY Mutual Insurance Company  NAIC 20990 EXAMINE YOUR POLICY EXCLUSIONS CAREFULLY.

P.O. Box 2100 Bloomington, Illinois 61702-2100 THIS FORM DOES NOT CONSTITUTE ANY PART OF
YOUR INSURANCE POLICY.
ILLINOIS INSURANCE CARD
WHAT TO DO AFTER AN ACCIDENT
BELSLEY LISA MAE & JOHN
1. Write down the make, model and license number of all
vehicles involved.
2. Write down the name, address and telephone number
of: (a) All parties involved, their insurance companies,
POLICY NUMBER A12A2175225 2008 CHEVR SILVER and policy numbers; (b) Any injured; (c) Any witnesses,
EFFECTIVE DATE Nov 08, 2015 police, ambulance companies, or wrecker companies.
EXPIRATION DATE May 08, 2016
VIN 2GCEC19C381310773 3. Don't discuss fault.
COVERAGE BODILY INJURY LIABILITY
PROPERTY DAMAGE LIABILITY 4. Report the accident to COUNTRY® at 1-866-COUNTRY
(1-866-268-6879) or visit us at our website
www.countryfinancial.com.
FOR SERVICE CALL YOUR FINANCIAL REPRESENTATIVE:
RICHARD K SHARPSHAIR AT (309)647-3225
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR PERSONS WHO ISSUE OR PRODUCE THIS CARD TO
VEHICLE FOR PRODUCTION UPON DEMAND. THE COVERAGE FRAUDULENTLY SHOW A POLICY OF INSURANCE IS IN
PROVIDED BY THIS POLICY MEETS THE MINIMUM LIABILITY FORCE, WHICH IN FACT IS NOT IN EFFECT, ARE LIABLE
INSURANCE LIMITS PRESCRIBED BY LAW. TO HEAVY FINES AND THEIR LICENSES OR
REGISTRATIONS MAY BE SUSPENDED OR REVOKED.

COUNTRY Mutual Insurance Company  NAIC 20990 EXAMINE YOUR POLICY EXCLUSIONS CAREFULLY.
P.O. Box 2100 Bloomington, Illinois 61702-2100 THIS FORM DOES NOT CONSTITUTE ANY PART OF
YOUR INSURANCE POLICY.
ILLINOIS INSURANCE CARD
WHAT TO DO AFTER AN ACCIDENT
BELSLEY LISA MAE & JOHN
1. Write down the make, model and license number of all
vehicles involved.
2. Write down the name, address and telephone number
of: (a) All parties involved, their insurance companies,
POLICY NUMBER A12A2175225 1999 PONTI GRPRIX and policy numbers; (b) Any injured; (c) Any witnesses,
EFFECTIVE DATE Nov 08, 2015 police, ambulance companies, or wrecker companies.
EXPIRATION DATE May 08, 2016
VIN 1G2WR521XXF246925 3. Don’t discuss fault.
COVERAGE BODILY INJURY LIABILITY
PROPERTY DAMAGE LIABILITY 4. Report the accident to COUNTRY® at 1-866-COUNTRY
(1-866-268-6879) or visit us at our website
www.countryfinancial.com.
FOR SERVICE CALL YOUR FINANCIAL REPRESENTATIVE:
RICHARD K SHARPSHAIR AT (309)647-3225
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR PERSONS WHO ISSUE OR PRODUCE THIS CARD TO
VEHICLE FOR PRODUCTION UPON DEMAND. THE COVERAGE FRAUDULENTLY SHOW A POLICY OF INSURANCE IS IN
PROVIDED BY THIS POLICY MEETS THE MINIMUM LIABILITY FORCE, WHICH IN FACT IS NOT IN EFFECT, ARE LIABLE
INSURANCE LIMITS PRESCRIBED BY LAW. TO HEAVY FINES AND THEIR LICENSES OR
REGISTRATIONS MAY BE SUSPENDED OR REVOKED.

INSTRUCTIONS:
-- Cut along solid lines, Fold in half; then place your insurance
card in the appropriate vehicle.
-- Please retain your current insurance card until its
expiration date.

ACCOUNT NUMBER: 1630218

11415a (00-06/94)
COUNTRY Mutual Insurance Company  NAIC 20990 EXAMINE YOUR POLICY EXCLUSIONS CAREFULLY.
P.O. Box 2100 Bloomington, Illinois 61702-2100 THIS FORM DOES NOT CONSTITUTE ANY PART OF
YOUR INSURANCE POLICY.
ILLINOIS INSURANCE CARD
WHAT TO DO AFTER AN ACCIDENT
BELSLEY LISA MAE & JOHN
1. Write down the make, model and license number of all
vehicles involved.
2. Write down the name, address and telephone number
of: (a) All parties involved, their insurance companies,
POLICY NUMBER A12A2175225 2005 CHEVR SUBURB and policy numbers; (b) Any injured; (c) Any witnesses,
EFFECTIVE DATE Nov 08, 2015 police, ambulance companies, or wrecker companies.
EXPIRATION DATE May 08, 2016
VIN 3GNFK16Z75G117603 3. Don't discuss fault.
COVERAGE BODILY INJURY LIABILITY
PROPERTY DAMAGE LIABILITY 4. Report the accident to COUNTRY® at 1-866-COUNTRY
(1-866-268-6879) or visit us at our website
www.countryfinancial.com.
FOR SERVICE CALL YOUR FINANCIAL REPRESENTATIVE:
RICHARD K SHARPSHAIR AT (309)647-3225
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR PERSONS WHO ISSUE OR PRODUCE THIS CARD TO
VEHICLE FOR PRODUCTION UPON DEMAND. THE COVERAGE FRAUDULENTLY SHOW A POLICY OF INSURANCE IS IN
PROVIDED BY THIS POLICY MEETS THE MINIMUM LIABILITY FORCE, WHICH IN FACT IS NOT IN EFFECT, ARE LIABLE
INSURANCE LIMITS PRESCRIBED BY LAW. TO HEAVY FINES AND THEIR LICENSES OR
REGISTRATIONS MAY BE SUSPENDED OR REVOKED.

INSTRUCTIONS:
-- Cut along solid lines, Fold in half; then place your insurance
card in the appropriate vehicle.
-- Please retain your current insurance card until its
expiration date.

ACCOUNT NUMBER: 1630218

11415a (00-06/94)