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Desc~ibe furnituro by oolor and style: •
/lbbreviations - Mod.. Trad.. Col.. UAedi.. Fr.P.
Describe appliance by size and brand. Verbal Ust3
[j Yes [=J No
Sofas ~ Style n'j TV ~
Co{or Size Brand
~ {~~ge Style 7Y _
O Chain Color Size 6rand
I O Occ. ~ ^
~ Chairs # Color Size B~and
~ ~ Stereo
i v Tables • S le vi T Brand
Z ~ry~ /y~~j ~u Room Ai r ~
Tables # S le /~f"~/ v Ca~ditioners # Size Brand
~ > R~ Z Range - '
~ Size Color < Brand
~~t - Refrigerator ,
Size ~ Cobr Brand
~ ~~S # • Dishwasher
T ' n' 6rand
Dinette Set • ~ Freezer '
Z # Pieces S le ~ Brand
~
W End Washer
~ Tabies i S le Brand
o Chairs # Style _ Dryer
ui Color • Srand (~G
~
o f- Sofa ~ Style Sewing IYlachine ~
i Color Brand ~
` Desk Vacuum - ~
~ z T B~
f - N Pawer TYPe
` o Lawn Mower Brand
~jS~uite ' R~
v~; p~~ S le ~ T Brartd
W ~
Suite Z 0~9a^
# p~~s S le ~ T Brand
~ Suite ' J MaJor -
~ # pieces S le J Power Tools
O •
Suite W ~~E~R ~ITRAf
~ # Pieces S le -
~ Rugs or Size N ~ (
W Ca ts # Color ~ _
m ~~n ~ ~ ~ a9 '~1 ~
Color
Lamps • •
T
When and Where was turniture purchased ? - ~t $
Customer's estimate of value ~
With what company is the furniture i~ured: Name ~
Poliry • Address:
Schedule •A• of Security /1g ent dated day of . 19~~ '
Or" i L.oan
itn~lss ( ate)
77 s:
t~ess) bate (Seal)
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