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Branch Address Stamp ~
SCHEDULE wAw SECtfRITY UST
Describe furniture by Dolor and style:
Trad.. Cot-. Meth.. Fr.P.
Abbreviations -Mod.. _ _
brat?d. _ , Verbif. List_ - -
Daser3be spRii~-~Y-ale-~ - Yes (_I ~ -
~G
, Tv o~ i
Sofas # Cobr Si:e Brand
TV
j ~ l,+uunge Sale Size Brand - -
+ O Chairs # CiD~- TY
} O Occ. Size Brand
CC Chairs # Color Stereo
End ~ T Pi ~ I Brand i,--
S to _ _
-
c~ Tables # - t
_ _ - - w -Roan ~ rend
z Coffee ~ u Condi rs # Sire ~
' Tables # ~ S is Z Rsnge _ ~
> Rugs < Brand
J Sire Color - Refrigerator
' W rat J Color -j Brand
Size o. Dishwasher
limps # Brand ~
< Freezer
Dinette Set Brand - -
~ Z # Pieoes P ~ S le Z"} Washer -
I _
End Brand ~
A a Tsbles # S le Dryer
II ~ o -Chairs # / SCtoylor ~ Brand _ ~
U ` W L~ S~ Sewing Machine .
u F- Soh le Brand d ' i1
~ ~ r Color Vacua Y -
W Desk Brand
Z T Power - TYPe `
C w lawn Yawe ~ Brand
~ Piano
Suite O T Brand .
4 # Pieoes S le w t)rga~
Suite ~ T Brand
{ ~ # Pieoes S le Major - _
Suite ' Power Touts
# w.~ s k ~ l9T9 SEA t 3~~ t 6 j
ti O suite w
oc # Pieces ~ Sizee v? FILED Ali(3 ki:CO[~D
o Rugs or _ ~
~ Chairf # Color i
11ECtiRO VERIFIED t
I La1mFs ~ r f'b :
T v
Cost S ~ v
When and Where was furniture purchased'
Custpner's estimate of value -
With what company is the furniture insured: Name _
Policy # Address:
day o t9 ~ .
Schedule "A' of Security rat dated the
Original No- i _ _
~ - i
a x
iD e) (Seal)
(Witness)
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