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# LE�75TROM,GAII, S�ate Farm Insprance <br /> III�d= LEDSTROM,GAIL, 23-L339-49 <br /> �OP�3"- 3465 COUIVTy ROA.D 6 Estimate: 23-L339-492 <br /> LONG LAI{E,IVil�j g5356-9657 Claim Number: 23_L339-492 <br /> Home: (952)473-8177 Policy Number: <br /> TYpe of Loss; � 23-G8-6705-6 <br /> Dedacrible: �ce List: MN�9F �,10 <br /> $1,000_00 Restoration/Service/Remodel <br /> Date of Loss: 6/25/Zp10 <br /> Date Inspe�te�: 7/102010 F=Factored in,D=Do Not Apply <br /> Line Icem Total S�°�r9 for DweWng <br /> Mad Sales Tax Reimb <br /> Subtotal <br /> � - 7��5�0 x 10,593.76 19,729.71 <br /> Cleaning Sales Tax ?70.70 <br /> @ 7.2754'o x $6.42 20,500.41 <br /> Replacement Cost�7alue <br /> 6.29 <br /> Less Depreciation(lnclnding Taxes) <br /> �s�educNble 20,506.70 <br /> Net Actual Cash Vaiue Payment (6,420.Z5) <br /> f�,Otl0.00) <br /> $13,086.45 <br /> Max�imnm Additional Amounts Ava�7able If Incurnd: <br /> Total Line item Depr���Rnciuding Taxes) <br /> Total M,vcim�Ad��oII��ounl Available If Iocu�red 6,420.25 <br /> Tota1 Amoant of Claim if in�d � <br /> 6,420.25 <br /> � $19,506.70 <br /> Punke,Sheliy , <br /> (866)787-8676 x 3204 <br /> ALL AMOUN'I'S pAyAgI,E�S��CT TO <br /> L�IITS OF.YOUR POLICY. �TE�MS, CONDI'i'IONS A1VD <br /> Date: 9/8/2p10 7;12 plVl <br /> Page:2 <br />