LIVING ROOM BATHROOM

ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE REPLACE (YEARS) REPLACE (YEARS) Carpeting, Rugs Shower Curtains Couch Mirrors Chairs Scales Desk & Desk Sets Medicine Cabinet Contents Book Cases Towels – Draperies & Curtains Bath Mat Sets Lamps Heater Coffee Tables Toilet Accessories Clocks Chests Mirrors Clothes Pictures Electric Utensils Stereo System Art/Room Dec. Set Shower Attachments Fireplace Fixtures Shelves TOTAL $ Art/Other Wall Decoration KITCHEN

ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE TOTAL $ REPLACE (YEARS) Floor covering DINING ROOM Table & Chairs Cabinets ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE REPLACE (YEARS) Stove Dining Room Set Cookers China Cabinet Dishes & Silverware Serving Tables Pots & Pans Electric Utensils Electrical Appliances Table Cloths & Napkins Clocks Silverware Food Chinaware Freezer & Contents Glassware Microwave Shelves Art/Room Decorations Art/Room Dec.

TOTAL $ TOTAL $ DEN OR GAME ROOM BEDROOMS — 1 and 2

ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE ITEM, MANUFACTURER, & Bedroom 1 Bedroom 2 REPLACE (YEARS) SERIAL NO. COST TO AGE COST TO AGE Carpeting, Rugs REPLACE REPLACE Couch Carpeting, Rugs Chairs Beds Lamps Mattresses, Box Springs Draperies & Curtains Chests Book Cases Dressing Tables Books Desks & Contents Stereo System Drapes & Curtains Lamps & Radios CDs, & Tapes Chairs Tables Mirrors Shelves Blankets, Spreads Art/Room Dec. Linen Video Equip. & Tapes Shelves Art/Room Decorations

TOTAL $ TOTAL $ $ HOBBY — SPORTS EQUIPMENT BEDROOMS — 3 and 4

ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE ITEM, MANUFACTURER, & Bedroom 3 Bedroom 4 REPLACE (YEARS) SERIAL NO. COST TO AGE COST TO AGE Hobby Material REPLACE REPLACE Carpeting, Rugs Photographic Equipment Beds Boats & Motors Mattresses, Box Springs Camping Equipment Chests Fishing Equipment Dressing Tables Hunting Equipment Desks & Contents Bicycles Drapes & Curtains Tennis Equipment Lamps & Radios Golf Clubs Chairs Exercise Equipment Mirrors Blankets, Spreads Linen Shelves Art/Room Decorations

TOTAL $ TOTAL $ $ CLOTHING and PERSONAL EFFECTS — Men & Boys CLOTHING and PERSONAL EFFECTS — Women & Girls

ITEM & MANUFACTURER COST TO AGE ITEM & MANUFACTURER COST TO AGE REPLACE (YEARS) REPLACE (YEARS) Coats Coats Hats Hats Suits Suits Slacks Sweaters Sweaters & Jackets Blouses Shirts Dresses Underwear Furs Socks Jewelry Neckties & Scarves Jewelry (cont.) Belts & Billfolds Watches Gloves Lingerie Rainwear & Umbrellas Shoes (all types) Sport Clothes Gloves Shoes (All Types) Rainwear & Umbrellas Cufflinks, Tieclasps, etc. Cosmetics & Perfume Watches

TOTAL $ TOTAL $ GARAGE — BASEMENT — ATTIC MISCELLANEOUS ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE REPLACE (YEARS) ITEM, MANUFACTURER, & SERIAL NO. COST TO AGE REPLACE (YEARS) Dryer Clothes Iron Canned Goods Trunks & luggage Work Bench Power & Hand Tools Tools (cont.) Tools (cont.) Garden Tools Shelving Lawn Furniture Vehicle 1 Vehicle 2 TOTAL $

TOTAL $ TOTALS PERSONAL INVENTORY

PRESENT VALUE LIVING ROOM DINING ROOM DEN & GAME ROOM KITCHEN BATHROOM BEDROOM NO. 1 BEDROOM NO. 2 BEDROOM NO. 3 BEDROOM NO. 4 CLOTHING & EFFECTS (Men/Boys) CLOTHING & EFFECTS (Women/Girls) GARAGE (YEARS) – BASEMENT – ATTIC HOBBY – SPORTS EQUIP. MISC ITEMS

TOTAL VALUE – PERSONAL INVENTORY $