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SCHEDULE "Ar' SECURITY LIST Branch Address Stamp ' i
Describe furniture uy color and style:
Abbreviations - 6Aod., Trad., Col., Medi., Fr.P. -
Describe appliance by size and brand. ! Verbal List?
I (_J Yes ~ _I No
Sofas # ' / Style yyf 'fV
Color Sire ~ Brand
~ Lounge Style ' TV
O Chairs # olor Size _ .Brand _ ~
O Occ. ~JO TV
D: Chairs # Color Size Brand_
End Stereo ~
u Tables # St le D ~ T v Brand
z Coffee W Room Air
Tables # St le U Conditioners # Size Brand j
Rugs ,,~[aw,~,r~. z Range
~ Size Color Q Brand -
Carpet Refrigerator
Size Color a Brand - ;
Lamps # Dishwasher
~ T o_ ~ Brand
Dinette Set `L Freezer
~ z # Pieces St le ~ Brand -
~ w End Washer
I O C _ ~ Brand ~ -
Tables # St le
~ o Chairs # ~ Style ~ Dryer
~ u~ Color Brand - - -
~ o F' Sofa Style Sewing Machine
z F Color Brand ,
Desk Vacuum V
Z Z T Brand
A _ Power TYPe
O ? Lawn Mower Brand ____i_._._-
Suite O ,Piano
# Pieces St le T Brand _ _
i; W Or an
Suite Z g
`n # Pieces St le T -Br'~od:~ _ - _ '
~ Suite J Major
O # Pieces Style _ ; ~ Power Toots - -
O Suite ' W
~ # Pieces St le ~ U - _
Q Rugs or Size ~
W Ca is # Color _
m Chairs # r
Color t
Lamps # _v
_ I~ICIF~COUN Y.fLA.
When and Where was furniture p chased ? o Cost 5 pp~~s. -
~ Customer's estimate of value ~ c:~~: ~ q~~KCIRWR
~ REC0~0 ~'fftlflEO_ '
With what company is the furniture insured: Name a -
Policy # Address: _ - ,/~`-!~~~j- ~j-
Schedule "A" of S greement d the _ day of 19 ~'~w~w
Orlgf No. ~ ~ `
itness) ~ ;
- (D e) - -(Seal) - - - -
~ '
(Witness) (Date) ~ (Seal)
Hess a.e ~a~'---- - - - - -
L-4!! fl R
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