(CONT)
 
(2) Policy #A-22ll80 Franklin D. and Anna Eleanor Roosevelt
 
There was no one present at time of accident except the two
occupants of other car and myself. State Trooper Gale
investigated accident and I am notifying the State.
 
My headlights were lit at time of accident and weather was
clear and pavement was dry. The headlights were lit on
other car also.
 
I was convicted once about two years ago for speeding in
Poughkeepsie and fined ten dollars,
 
I have read this three page statement and it is true and
correct.
 
                                    MONFORT SNYDER
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