Fdx1021572251 1-1

Send all claims corresponden ce to:
Farmers Insuran ce Total Loss - COE
PO Box 108815
Oklahoma City OK 73101-8815
FAX: (877) 217-1389
Email: claimsdocuments@farmersinsuran ce.com

June 27, 2012

Hortencia Moriel
905 E Madison Ave
Lovington, NM 88260

Policy: 0189289879
Claim Number: 1021572251-1-1
Date of Loss: 6/12/2012 12:00:00 AM
Vehicle: 2002 Buick Lesabre Custom

Dear Mrs. Moriel:

Your recent claim has resulted in a total loss settlement on your automobile. If your policy is still in force, there are
several good reasons to continue your policy coverage.

For example, even if you have not purchased another automobile, you would be insured while driving a borrowed
or non-owned vehicle. If you do buy a replacement automobile, it would be automatically insured. Please consult
your policy for the exact terms and conditions of coverage.

We urge you to contact your agent, if you have not already done so, to make further arrangements for your
coverage needs.

Sincerely,
Farmers Insurance Company of Arizona

Craig McGriff
Total Loss Specialist

ANY PERSON WHO KNOWINGLY PRE SENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR
BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATI ON IN AN APPLICATI ON FOR INSURANCE IS GUILTY OF A
CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES.

INSTRUCTIONS FOR
TOTAL LOSS VEHICLE DOCUMENTS

If you need assistance completing the forms please call Whitney Kelsey at 1-800-445-
8055 Ext. 24923.

Please sign the enclosed lien release letter.

Sign the Power of Attorney, Odometer Disclosure Statement, and Bill of Sale. The Power of Attorney
MUST be notarized. The Odometer Disclosure Statement and Bill of Sale do not need to be notarized.

Sign the Power of Attorney exactly as the owner’s name is printed on the title. Abbreviations, middle
initials/names, etc. must be included.

All registered owners listed on the title MUST sign the Power of Attorney (name must be same as on title)
if there is more than one owner named on the title and the title states “OR” or “AND OR”, only one
signature is required on the Power of Attorney. If the title has “AND” in between the registered owners
listed on the title, all registered owners listed on the title must sign the Power of Attorney.

Sign the forms only where indicated by the “X”.

Review the Bill of Sale and sign the form only where indicated. If vehicle jointly owned all owners must
sign and enter the date signed.

Please put your vehicle key/keys in the enclosed “key” envelope. If your keys are with your vehicle, please
indicate so on the “key” envelope.

Return the Power of Attorney (notarized), Bill Of Sale, Odometer Disclosure Statement, Copy of your
registration, and all keys in the provided prepaid envelope.

You have received a shipping label to return your paperwork. Please call Fed Ex at 1-800-
GO FED EX (1-800-463-3339). Do not return your paperwork through the US Post Office
unless you are directed to do so by either Fed Ex.

IMPORTANT: DO NOT MARK THROUGH, INITIAL ERRORS, OR USE WHITE OUT ON
THESE FORMS. DOING THIS WILL ONLY DELAY YOUR PAYMENT.

Thank You


Send all claims correspondence to:
Farmers Insurance Total Loss - COE
PO Box 108815
FAX: (877) 217-1389
Email: claimsdocuments@farmersinsurance.com

June 27, 2012

RE: Claim Number: 1021572251-1-1
Loss Date: 6/12/2012 12:00:00 AM
VIN: 1G4HP54K024120976
Year/Make/Model: 2002 Buick Lesabre Custom

Dear Mrs Moriel:

Your vehicle has been determined to be a total loss. The mileage, options, condition, and title history of your
vehicle are taken into account when preparing your vehicle valuation and this information is utilized in order to
establish the actual cash value of your vehicle.

The actual cash value of your total loss vehicle includes consideration for prior unrepaired damage and your vehicle
title history. These considerations accounted for an adjustment of $ 0 in the value of your vehicle. The following is
the breakdown of your settlement:

Actual Cash Value: $5247.00
Sales Tax: $157.41
DMV Fees: $51.00
Less: Deductible -$500.00

Total Amount $4955.41

I am committed to earning your satisfaction with the claims process. If you have any questions or concerns, please
feel free to contact me at 1-800-445-8055ext.22747.

Sincerely,
Farmers Insurance Company of Arizona

Craig McGriff
Total Loss Specialist


PO Box 108815
FAX: (877) 217-1389

ODOMETER DISCLOSURE STATEMENT
FEDERAL LAW (AND STATE LAW, IF APPLICABLE) REQUIRES THAT YOU STATE THE MI LEAGE UPON TRANSFER OF
OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR
IMPRISONMENT.

I, STATE THAT

THE ODOMETER READS 140000 (NO TENTHS) MILES, AND TO THE BEST OF MY KNOWLEDGE REFLECTS THE
ACTUAL MI LEAGE OF THE VEHICLE DESCRIBED BELOW, UNLE SS ONE OF THE FOLLOWING STATEMENTS I S
CHECKED.

I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE
AMOUNT OF MI LEAGE IN EXCESS OF ITS MECHANICAL LIMITS.

I HEREBY CERTIFY THAT THE ODOMETER READING I S NOT THE ACTUAL MILEAGE. WARNING!
ODOMETER DISCREPANCY.

2002 Buick Lesab re Custom ______________
Year Make Model Body Typ e

VIN: 1G4HP54K024120976
X
Signature o f Transferor (SELLER) Print Own ers Name

Date Signed

905 E Madison Ave
Address
Lovington NM 88260 5757258898
City State Zip Telephone Number

Signature o f Transferee (BUYER) PRINTED NAME

Transferee Name (BUYER)

Address

City State Zip Telephone Number


PO Box 108815
FAX: (877) 217-1389

POWER OF ATTORNEY

I / (We) hereby appoint Farmers Insurance Company of Arizona as my/our Attorney-In-Fact to
sign my/our name to any forms necessary for a transfer to my/our right, title, and interest to the
vehicle described below.

Make: Buick Year: 2002 Model: Lesabre Custom
License Number: _________________ Claim Number: 1021572251-1-1
VIN: 1G4HP54K024120976

Signature of Owner: X Date:

Signature of Joint Owner: X Date:

For Notary Use Only

State of On this day of . 20 , before me,

County of
The undersigned Notary Public, personally appeared and,

Was personally known to me
Proved to me on the basis of satisfactory
evidence to be the person(s) whose name(s) are subscribed to within the
instrument, and knowledge that he/she/they executed it.

WITNESS my hand and official seal.

Notary’s Signature


PO Box 108815
FAX: (877) 217-1389

June 27, 2012

TO: FROM:
CREDIT ACCEPTANCE CORPORATION Hortencia Moriel
905 E Madison Ave
25505 W 12 MILE RD Lovington, NM 88260
SOUTHFIELD, MI 48034
phone: 8003143864

Loan or File #: 36389734 DOL: 6/12/2012 12:00:00 AM
Customer Name: Hortencia Moriel Mileage: 140000
Policy: 0189289879 Deductible $500.00
Date of Loss: 6/12/2012 12:00:00 AM ACV: $5247.00
Claim Number: 1021572251-1-1
VIN: 1G4HP54K024120976
Vehicle: 2002 Buick Lesabre Custom

Attention: Loan Payoff/

This will advise you the vehicle listed above has been declared a total loss. Enclosed is payment in the amount of $3265.59 to
clear the lien against the title. The enclosed payment is in consideration of a properly signed title returned to us within 10 days
of the date of this letter. You are not authorized to negotiate payment if you do not release the title as set forth above. My
signature below authorizes you to endorse the title (or lien release) and forward it to Farmers Insurance Company of Arizona
at the address listed below.

**NOTE** If my loan carries GAP insurance through any company other than Farmers Insurance Company of
Arizona, I will be solely responsible for providing my GAP insurance company with the necessary documentation.

IMPORTANT – Please return a copy of this letter with the title.

Quoted Payoff Amount $3265.59 By:

X ___________________________________ ________________________
Signature Date:

Farmers Insurance Total Loss - COE
PO Box 108815
ATTN: Whitney Kelsey


Return Label

1021572251-1-1


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