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Javier Verduzco 8 Hayes St San Rafael, CA 94901 February 21, 2012 Brian Gill ABC Insurance 12 45th St San

Rafael, CA 94901 RE: Insurance Policy: 123456 Insured: Javier Espinoza Owner: Javier Verduzco Dear Brian Gill: I am writing to instruct you to make the following change(s) to the above policy. There has been a change in a primary beneficiary's name. Javier Espinoza is now Javier Verduzco. The change from Javier Espinoza to Javier Verduzco simply reflects a name change due to a personal reason. Please contact me at the address given above if you have any questions or need additional information. Please send me a confirmation letter and, if necessary, a form to make this change. Thank you for your assistance.


Javier Verduzco

_________________ Spouse of Javier Verduzco