Gentlemen: Attached is Draft No. ___, for $___, issued by the ______ Insurance Company in payment of ___ loss which damage the buildings on the farm of _________, of _______ County, State of _______.

This draft has been endorsed by the undersigned payees who request that you collect these funds and issue cashier's checks to the following payees for the following amounts:

________, First Mortgage $___

________, Second Mortgage $___

________, Third Mortgage $___

The balance only, if any, will be paid to ________, the owner of the property.