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SCHEDULE "l~?" SECURI7Y LIST Branch Address Stamp
Oescribe furniture by color and style:
Abbreviations - Mod., Trad., Col.; Medi., Fr.P. ~
Describe appliance by size and brand. ~ Verbal List? `
Yes No ~
Sofas t ~ Style ~j ~
Color S e r/O{~ n~L~•~ Brand lJ/~~• ~
~ Lounge ~ StY~e ~ TV ~ i/ .
O Chairs ~ Color "r Size d~,C~~~t~ Brand
O Occ. t ~ ~ ~
ac Chairs Color ~t ~ Size Brand ~
End G ~ E~'~!-5 v? T e~ ~D Brand l4'i
~i y
c7 Tabies i / S le
C'~~~5 .w Room Air
z Coffee ` V Canditioners # Size Brend '
- Tables f~ St le
~ Ru95 z Rar~ge n ~ .
- •Size Color ~ . Brand t~• ' -
J Carpet - Refrigerator ~ •
~ Color ~ Brand ~ '
Size •
' ~~S # ~ a Dishwasher_ ~i
T a Brand 1.~, e~
~ Z, Dinette ~t ~ St le d Brand r
~ Pieces
b W End Washer ~ ~ :
p ~ Tables # S le Brand ~
tY o Chairs # Sty~e ~rYer , ;
W ~ ~~or Brand ~ ~
~~j ~ o F- Sofa . Style ~ Sewing Machi^~
` ~z ~ Color Brand / ~~~~i~ ~'/1 ~/~~e ~/~~`f' •
;
~ w Desk / T Vacuum Ue~ :
i B rand
; z '
, _ ~ Power TYPe /
k ~P p Lawn Mower / Brand !~N
f ~ ~ Piano ~ ;
~ , Suite
# Pieces 5 le ~G'~~~^'~~ ~ T Brand
~ ' W Org~ a
~ Suite , / S 'e 2 Brand ~
# Pieces a
~ Suite Ma'or ,
~ ; o ~ ~ 3 F±! ED 1.~1D RECORDED~
# Pieces ~ St le ~ Power Tools r :
' p . - . ~,.:1
Suite w
' ~ # Pieces St le V ~
i
~ Rugs or Si ze N •
Color _ '
Car ts # , i
~ m Chairs t ~
Cotor
~ ' - ~
; Lamps ~ _ , ~
~ T :r+~ : r~
~ .
i,1t. ,
~ When and Where was furniture purchased t Cost S ~
~ Customer's estimate of vafue Q ~ /
With what company is the furniture insured: Name ~f ~
~ Policy Address: .
~ Sch e"A" f Se u Ag nt dated the day of . 19
$ Origin e ~ j'.
~ - ~
Spate)~~;i `
~ (S r-- ~ c!~~
,,Y' ' . ; , - . f -
(Wilness) . • ~ [Date) • i5eal) -
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~ L-48 '
soo~ 303 P~ 54T
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