Living Room
Article Estimated
Value
Chesterfield  
Chair(s)  
Lamp(s)  
Table(s)  
Radio  
HiFi - Stereo  
TV Set  
Rug(s) and Carpet(s)  
Bric-a-brac  
Clock(s)  
Paintings, Pictures  
Curtains, Drapes  
Piano or other  
Musical Instruments  
Other  
Total $
Dining Room
Table  
Table  
China Cabinet  
Buffet  
Serving Table  
Rug(s) and Carpet(s)  
Curtains, Drapes  
Electric Appliances  
Other  
Total $
Family Room
Chair(s)  
Curtains and Drapes  
Chesterfield  
Table(s)  
Lamp(s)  
Desk  
Bric-a-brac  
Other  
Total $
Kitchen
Step-stool  
Table  
Dinette Set  
Electric Appliances  
Dishes  
Cutlery  
Utensils  
Pots and Pans  
Bowl, etc.  
Stove  
Refrigerator  
Other  
Total $
Bathrooms
   
   
   
   
   
   
   
   
   
Total $
Patio
   
   
   
   
   
   
Total $
Bedroom #1
Chair(s)  
Bed(s)  
Bedding  
Night Table  
Dressing Table  
Bench  
Chest of Drawers  
Mirror(s)  
Rugs(s)  
Lamp(s)  
Bric-a-brac)  
Clock(s)  
Curtain(s)  
Drapes  
Other  
Total $
Bedroom #2
Chair(s)  
Bed(s)  
Bedding  
Night Table  
Dressing Table  
Bench  
Chest of Drawers  
Mirror(s)  
Rugs(s)  
Lamp(s)  
Bric-a-brac)  
Clock(s)  
Curtain(s)  
Drapes  
Other  
Total $
Bedroom #3
Chair(s)  
Bed(s)  
Bedding  
Night Table  
Dressing Table  
Bench  
Chest of Drawers  
Mirror(s)  
Rugs(s)  
Lamp(s)  
Bric-a-brac)  
Clock(s)  
Curtain(s)  
Drapes  
Other  
Total $
Bedroom #4
Chair(s)  
Bed(s)  
Bedding  
Night Table  
Dressing Table  
Bench  
Chest of Drawers  
Mirror(s)  
Rugs(s)  
Lamp(s)  
Bric-a-brac)  
Clock(s)  
Curtain(s)  
Drapes  
Other  
Total $
Linens and Clothing
Coats  
Raincoats  
Jackets  
Suits  
Dresses  
Sport Coats  
Shirts  
Slacks  
Sweaters  
Blouses  
Slacks  
Skirts  
Belts  
Handkerchiefs  
Socks  
Handkerchiefs  
Hosiery  
Ties  
Underwear  
Lingerie  
Sleepwear  
Shoes  
Boots  
Rubbers  
Slippers  
Hats  
Handbags  
Sportswear  
Sheets  
Pillow Cases  
Spreads  
Quilts  
Blankets  
Towels  
Face Cloths  
Other  
Total $
China / Crystal
   
   
   
   
   
   
Total $
Silver / Jewelry / Collections
   
   
   
   
   
   
   
   
   
   
   
   
   
Total $
Basement / Garage / Tools
   
   
   
   
   
   
   
   
   
   
   
   
   
Total $
Miscellaneous
   
   
   
   
   
   
   
   
Total $

SUMMARY

  1. Living Room Total: _________________
  2. Family - Recreation Room Total: _________________
  3. Kitchen Total: _________________
  4. Bathroom(s) Total: _________________
  5. Verandah or Patio Total: _________________
  6. Bedroom No. 1 Total: _________________
  7. Bedroom No. 2 Total: _________________
  8. Bedroom No. 3 Total: _________________
  9. Bedroom No. 4 Total: _________________
  10. Other Room(s) Total: _________________
  11. Linens and Clothing Total: _________________
  12. China and Crystal Total: _________________
  13. Silver, Jewelry, Furs, Collections Total: _________________
  14. Basement and Garage Total: _________________
  15. Miscellaneous Total: _________________

GRAND TOTAL $ _________________

Present Insurance $ _________________
Additional Insurance Needed $ _________________