PREMIER LIFE INSURANCE
Policy Advance (Loan) Agreement
[...] 1908 and later
paid-up policies
$1000.00
⟨I, the⟩ undersigned, in consideration of the advance by the PREMIER LIFE INSURANCE COMPANY, of one thousand Dollars, am the sole security ⟨Policy⟩ No. 36411-A issued by said Company on the life of Amos Hart, hereby [...] as follows:
[...]
[...] may be paid to Amos Hart [...] this 14 [...] 1927.
Amos Hart
Form 2143A
Form 2143A