SERVICE OF PROCESS
ON INSURANCE COMMISSIONER
PURSUANT TO  CONN. GEN. STAT. §38a-25

To Whom It May Concern:
I have been directed by the attorney filing the attached action to serve the Insurance Commissioner on behalf of:

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Name of Insurance Company

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Address of Insurance Company  

In accordance with Connecticut General Statutes §38a-25(a)(7).

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Signature of State Marshal

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Print Name of State Marshal

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Date