HALSTAD MUTUAL FIRE INSURANCE CO.

FORMS
Form Name	Form #	Form Description & Use
Homeowners Application	HG 80 (1/06)	HG2, HG3, Mobile Home-Gaurd, Tenant Mobile Home-Guard
Farmate/Farm-Guard Application	RC 289 (1/06)	Commander & Custom Farm
Dwelling Application	RC 80 (1/06)	Dwelling Property, Mobile Home, Rented Dwelling
Change in Coverage	RC 47 (7/81)
Notice of Loss	ACORD 1 (7/97)
Water Backup of Sewer or Drain Coverage	RC 368 & HG 368	Use for water/sewer backup coverage over $1000
Schedule of Personal Property	HG 141A (01/05)

Home

Harlan J Rise, Manager

Cheryl Christianson, Administrator

Clayton Arthurs, Adjustor/Inspector

P.O. Box 297

Halstad, MN 56548

218-456-2174