NON-CASH CHARITABLE CONTRIBUTIONS
IMPORTANT RECORDS TO CLAIM A CHARITABLE CONTRIBUTION
You need to keep records in order to deduct your donations. Follow these five simple steps:
1. Tally the items donated and indicate the condition of the items by recording the quantities
under the “EXCELLENT” or “GOOD” categories. Take pictures or video of gifted items.
2. If your total contributions are over $500 for the year, then also record the date you
acquired the property, how you acquired it and your cost/basis for the property.
3. Estimate the original purchase price of the donated goods and record the total.
IF THE GIFT IS WORTH OVER $5,000 PLEASE CONTACT OUR OFFICE FOR
ADDITIONAL INFORMATION. THE GREATER THE VALUE, THE MORE
DETAILED RECORDS YOU NEED!!!
4. Record the dates, names and addresses of the organizations receiving your donations.
5. Obtain a SIGNED, DATED receipt for your donations. Your donations must be made by
December 31, of the tax year, in order to claim this donation on your current tax return. Note:
Contributions of motor vehicles, boats and airplanes require form 1098-C from donee
organizations.
Men’s Clothing Page 1 Total Amount $___________________
Women’s Clothing Page 4 Total Amount $___________________
Boy’s Clothing Page 7 Total Amount $___________________
Girl’s Clothing Page 10 Total Amount $___________________
Infant’s Clothing Page 15 Total Amount $___________________
Toddler’s Clothing Page 13 Total Amount $___________________
Children’s Accessories Page 22 (Included in Household Goods Total)
Household Goods Page 16 Total Amount $___________________
TOTAL OF ALL CATEGORIES ABOVE …………………. . $ ___________________
1
NON-CASH CHARITABLE CONTRIBUTIONS
MEN’S CLOTHING
EXCELLENT GOOD TOTAL
Value x Number = Amount
SHIRTS
Dress, Long Sleeve _____ $16.00 _____ $10.00 ___________
Short Sleeve _____ 12.00 _____ 8.00 ___________
Casual, Long Sleeve _____ 18.00 _____ 10.50 ___________
Short Sleeve _____ 14.00 _____ 10.00 ___________
Turtleneck _____ 8.00 _____ 6.00 ___________
Sport Pullover:
Long Sleeve _____ 15.00 _____ 10.50 ___________
Short Sleeve _____ 12.00 _____ 9.00 ___________
Work, Short Sleeve _____ 10.00 _____ 8.00 ___________
Long Sleeve _____ 12.00 _____ 8.00 ___________
SWEATERS, Dress or Casual
Pullover, Long Sleeve _____ 20.00 _____ 13.50 ___________
Vest _____ 12.00 _____ 8.00 ___________
Cardigan _____ 20.00 _____ 12.00 ___________
V-Neck _____ 12.00 _____ 8.00 ___________
Turtleneck _____ 14.00 _____ 8.00 ___________
SLACKS AND PANTS
Dress _____ 20.00 _____ 12.00 ___________
Casual, Denim _____ 18.00 _____ 10.00 ___________
Corduroy _____ 15.00 _____ 10.00 ___________
Other _____ 14.00 _____ 10.00 ___________
SUMMERWEAR
Shorts, Denim _____ 10.00 _____ 5.00 ___________
Other _____ 8.00 _____ 7.00 ___________
Shirts, Tank _____ 5.00 _____ 3.00 ___________
T-Shirt _____ 6.00 _____ 4.00 ___________
SWIMWEAR _____ 8.00 _____ 5.00 ___________
EXERCISE
Shirts:
Sweatshirt, Long Slv _____ 15.00 _____ 8.00 ___________
Sweatshirt, Short Slv _____ 10.00 _____ 6.00 ___________
Nylon, Long Sleeve _____ 8.00 _____ 5.50 ___________
Pants:
Fleece _____ 8.00 _____ 6.00 ___________
Nylon _____ 10.00 _____ 8.00 ___________
(continued)
2
MEN’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Shorts: Fleece _____ 5.00 _____ 3.00 ___________
Nylon _____ 6.00 _____ 5.00 ___________
Suits (Matching Pants & Shirt)
Fleece _____ 20.00 _____ 12.00 ___________
Nylon _____ 20.00 _____ 14.00 ___________
Jackets, Fleece _____ 12.00 _____ 10.00 ___________
Insulated, Fleece _____ 14.00 _____ 11.00 ___________
Nylon _____ 18.00 _____ 12.00 ___________
Miscellaneous - Jock _____ 2.00 _____ 1.00 ___________
SUITS, Dress
Two-Piece _____ 92.00 _____ 41.00 ___________
Vest _____ 10.00 _____ 8.00 ___________
Coat _____ 40.00 _____ 22.00 ___________
Slacks _____ 18.00 _____ 14.00 ___________
Casual, Sport Coat _____ 35.00 _____ 20.00 ___________
Custom Tailored, 2 piece _____ 85.00 _____ 60.00 ___________
UNDERGARMETS
Shirts:
Long Slv, insulated _____ 3.00 _____ 2.50 ___________
T-Shirt _____ 4.00 _____ 2.00 ___________
Pants, Insulated _____ 3.00 _____ 2.00 ___________
Underwear, Regular _____ 2.00 _____ 1.00 ___________
Boxer _____ 3.00 _____ 1.00 ___________
Bikini _____ 2.00 _____ 1.00 ___________
Socks (pair) Dress _____ 2.00 _____ 1.00 ___________
Other _____ 2.00 _____ 1.00 ___________
SLEEPWEAR
Pajamas _____ 8.00 _____ 7.00 ___________
Robe _____ 14.00 _____ 10.00 ___________
OUTERWEAR
Dress Winter Coats, Wool _____ 55.00 _____ 30.00 ___________
All Weather _____ 42.00 _____ 24.50 ___________
Other _____ 24.00 _____ 18.00 ___________
Casual Winter Coats, Ski _____ 34.00 _____ 14.00 ___________
Other _____ 26.00 _____ 18.00 ___________
Leather Coats, Dress/Casual _____ 65.00 _____ 30.00 ___________
Dress Jackets, Wool _____ 38.00 _____ 21.00 ___________
Casual Jackets, Cloth _____ 20.00 _____ 14.00 ___________
Nylon _____ 20.00 _____ 12.00 ___________
(continued)
3
MEN’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Rainwear, Coat _____ 14.00 _____ 12.00 ___________
Vests, Winter _____ 15.00 _____ 10.00 ___________
Suede _____ 24.00 _____ 16.00 ___________
Miscellaneous, Coveralls _____ 12.00 _____ 10.00 ___________
Ski Bibs _____ 24.00 _____ 14.00 ___________
Outfit: Snowmobile _____ 34.00 _____ 16.00 ___________
SHOES AND BOOTS
Dress, Shoes with laces _____ 20.00 _____ 11.00 ___________
Shoes, Slip-on _____ 25.00 _____ 12.00 ___________
Casual, Shoes with laces _____ 17.00 _____ 12.00 ___________
Shoes, Slip-on _____ 16.00 _____ 10.00 ___________
Boots, Leather _____ 25.00 _____ 14.50 ___________
Boots, Slip-on _____ 15.00 _____ 11.00 ___________
Boots, Western _____ 25.00 _____ 14.00 ___________
Boots, Hiking _____ 14.00 _____ 8.00 ___________
Boots, Hunting _____ 12.00 _____ 10.00 ___________
Sport, Leather Sneakers _____ 22.00 _____ 10.50 ___________
Sneakers, Other _____ 20.00 _____ 9.00 ___________
Misc, Boots, Snow _____ 10.00 _____ 8.50 ___________
Slippers _____ 5.00 _____ 3.50 ___________
ACCESSORIES
Dress Gloves _____ 5.00 _____ 4.00 ___________
Ties: Silk _____ 10.00 _____ 6.00 ___________
Clip-on _____ 4.00 _____ 2.50 ___________
Other _____ 6.00 _____ 4.00 ___________
Belts, Dress-Leather _____ 12.00 _____ 7.00 ___________
Casual _____ 8.00 _____ 5.00 ___________
Cloth _____ 6.00 _____ 3.00 ___________
Suspenders: Button-on _____ 5.00 _____ 3.00 ___________
Clip-on _____ 5.00 _____ 3.00 ___________
Caps: Winter _____ 5.00 _____ 3.00 ___________
Summer _____ 5.00 _____ 2.50 ___________
Sun Visor _____ 2.00 _____ 1.00 ___________
Stocking _____ 4.00 _____ 3.00 ___________
Hats: Dress _____ 10.00 _____ 5.00 ___________
Cowboy _____ 15.00 _____ 9.00 ___________
Scarves: Dress _____ 5.00 _____ 4.00 ___________
Other _____ 4.00 _____ 3.00 ___________
Handkerchiefs _____ 2.00 _____ 1.00 ___________
TOTAL MEN’S CLOTHING $ __________
4
WOMEN’S CLOTHING
EXCELLENT GOOD TOTAL
BLOUSES AND SHIRTS
Dress, Long Sleeve _____ 18.00 _____ 12.00 ___________
Short Sleeve _____ 16.00 _____ 10.00 ___________
Casual, Long Sleeve _____ 16.00 _____ 10.00 ___________
Short Sleeve _____ 12.00 _____ 8.00 ___________
Turtleneck _____ 10.00 _____ 6.00 ___________
SWEATERS, Dress or Casual
Pullover: Long Sleeve _____ 24.00 _____ 14.00 ___________
Turtleneck _____ 18.00 _____ 10.00 ___________
Vest _____ 14.00 _____ 8.00 ___________
Cardigan _____ 20.00 _____ 11.00 ___________
V-Neck _____ 14.00 _____ 9.00 ___________
SLACKS AND PANTS
Dress _____ 22.00 _____ 14.00 ___________
Casual, Denim _____ 15.00 _____ 10.00 ___________
Corduroy _____ 14.00 _____ 8.00 ___________
Other _____ 14.00 _____ 9.00 ___________
DRESSES
Dress _____ 35.00 _____ 28.00 ___________
Casual _____ 35.00 _____ 18.00 ___________
Summer _____ 22.50 _____ 16.00 ___________
Wool _____ 24.00 _____ 15.50 ___________
SUITS, Skirt & Jacket _____ 65.00 _____ 33.00 ___________
Slacks & Jacket _____ 50.00 _____ 29.00 ___________
Jacket _____ 38.00 _____ 20.00 ___________
Skirt _____ 18.00 _____ 12.00 ___________
Slacks _____ 16.00 _____ 10.00 ___________
Custom Tailored:
Skirt & Jacket _____ 60.00 _____ 48.50 ___________
Slacks & Jacket _____ 65.00 _____ 50.00 ___________
Formals, Long _____ 70.00 _____ 34.00 ___________
Short _____ 60.00 _____ 42.00 ___________
Wedding Gown _____ 175.00 _____ 125.00 ___________
SKIRTS, Denim _____ 15.00 _____ 10.00 ___________
Corduroy _____ 12.00 _____ 9.50 ___________
Other _____ 17.00 _____ 9.00 ___________
(continued)
5
WOMEN’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Mini: Denim _____ 12.00 _____ 9.00 ___________
Leather _____ 22.00 _____ 14.50 ___________
Other _____ 14.00 _____ 10.00 ___________
JUMPERS
Dress or Casual _____ 26.00 _____ 18.00 ___________
SUMMERWEAR
Shorts, Denim _____ 12.00 _____ 8.00 ___________
Other _____ 12.00 _____ 7.00 ___________
Tops, Tank _____ 6.00 _____ 4.50 ___________
T-Shirt _____ 10.00 _____ 6.00 ___________
Other _____ 8.00 _____ 5.50 ___________
Swimsuits, One Piece _____ 12.00 _____ 8.00 ___________
Two Piece _____ 10.00 _____ 8.00 ___________
Maternity _____ 10.00 _____ 7.00 ___________
EXERCISE, Shirts:
Sweatshirt, Long Sleeve _____ 14.00 _____ 8.00 ___________
Sweatshirt, Short Sleeve _____ 9.00 _____ 7.00 ___________
Nylon, Long-Sleeve _____ 9.00 _____ 6.50 ___________
Pants, Fleece _____ 10.00 _____ 6.00 ___________
Nylon _____ 10.00 _____ 8.00 ___________
Shorts, Nylon/Fleece _____ 7.00 _____ 5.00 ___________
Jackets, Fleece with hood _____ 14.00 _____ 10.00 ___________
Nylon with hood _____ 12.00 _____ 8.00 ___________
Nylon, insulated _____ 15.00 _____ 11.00 ___________
Leotards _____ 9.00 _____ 6.00 ___________
MATERNITY
Dress Tops, Long Sleeve _____ 12.00 _____ 8.00 ___________
Short Sleeve _____ 10.00 _____ 7.00 ___________
Casual Tops, Long Sleeve _____ 10.00 _____ 7.50 ___________
Short Sleeve _____ 10.00 _____ 5.50 ___________
Slacks, Dress _____ 12.00 _____ 9.00 ___________
Casual _____ 11.00 _____ 8.00 ___________
Jumpers _____ 20.00 _____ 13.00 ___________
Dresses, Dress _____ 34.00 _____ 19.00 ___________
Casual _____ 25.00 _____ 16.00 ___________
Suits, Skirt & Jacket _____ 32.00 _____ 17.00 ___________
Slacks & Jacket _____ 30.00 _____ 18.00 ___________
Skirt _____ 14.00 _____ 10.00 ___________
(continued)
6
WOMEN’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
UNDERGARMENTS
Bras, Regular _____ 6.00 _____ 3.00 __________
Sport _____ 5.00 _____ 3.00 __________
Panties, Regular _____ 2.50 _____ 1.00 __________
Bikini _____ 2.00 _____ 1.00 __________
Slips, Full _____ 6.00 _____ 4.00 __________
Half _____ 5.00 _____ 3.00 __________
Camisole _____ 6.00 _____ 3.00 __________
Socks, (pair), Dress _____ 2.00 _____ 1.00 __________
Other _____ 2.00 _____ 1.00 __________
Tights _____ 3.00 _____ 1.50 __________
Girdle _____ 3.00 _____ 2.00 __________
SLEEPWEAR
Nightgown _____ 12.00 _____ 8.00 __________
Pajamas- Matching set _____ 15.00 _____ 9.50 __________
Robe _____ 18.00 _____ 10.50 __________
Teddies _____ 8.00 _____ 6.00 __________
Night Shirt _____ 10.00 _____ 6.00 __________
OUTERWEAR, Dress Winter Coats
Wool Coat/Cape _____ 58.00 _____ 32.50 __________
All Weather _____ 48.00 _____ 29.00 __________
Other _____ 40.00 _____ 20.00 __________
Casual Winter Coats, Ski _____ 30.00 _____ 20.00 __________
Other _____ 34.00 _____ 18.00 __________
Leather, Dress or Casual _____ 80.00 _____ 50.00 __________
Jackets, Dress, Wool _____ 40.00 _____ 24.50 __________
Cloth _____ 25.00 _____ 15.50 __________
Jackets-Casual, Cloth _____ 18.00 _____ 10.00 __________
Nylon _____ 12.00 _____ 10.00 __________
Rainwear, Coat _____ 18.00 _____ 14.00 __________
SHOES AND BOOTS
Dress, Shoes, Leather _____ 14.00 _____ 12.00 __________
Shoes, Other _____ 12.00 _____ 10.00 __________
Pumps, Leather _____ 14.00 _____ 10.00 __________
Boots, Leather _____ 24.00 _____ 14.50 __________
Boots, Other _____ 14.00 _____ 12.00 __________
Casual, Shoes with laces _____ 12.00 _____ 10.00 __________
Shoes, Slip-on _____ 14.00 _____ 8.00 __________
Boots, Leather _____ 28.00 _____ 14.00 __________
Boots, Other _____ 14.00 _____ 10.00 __________
(continued)
7
WOMEN’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Sport, Sneakers, Cloth _____ 10.00 _____ 8.00 ___________
Sneakers, Other _____ 15.00 _____ 8.00 ___________
Boots, Snow _____ 12.00 _____ 8.00 ___________
Slippers _____ 5.00 _____ 3.00 ___________
Tap _____ 6.00 _____ 5.00 ___________
Water Socks _____ 2.00 _____ 1.00 ___________
Sandals, Leather _____ 10.00 _____ 8.00 ___________
ACCESSORIES
Belts, Leather _____ 10.00 _____ 6.50 ___________
Other _____ 6.00 _____ 4.00 ___________
Scarves, Dress _____ 8.00 _____ 5.50 ___________
Other _____ 5.00 _____ 3.00 ___________
Gloves: Casual or Dress _____ 6.00 _____ 4.00 ___________
Mittens _____ 4.00 _____ 3.00 ___________
Purses, Dress _____ 18.00 _____ 10.00 ___________
Leather _____ 22.00 _____ 14.00 ___________
Other _____ 14.00 _____ 10.00 ___________
Costume Jewelry:
Necklace _____ 20.00 _____ 18.00 ___________
Earrings _____ 6.00 _____ 4.00 ___________
Bracelets _____ 14.00 _____ 10.00 ___________
Watches _____ 18.00 _____ 6.00 ___________
Pins _____ 8.00 _____ 6.00 ___________
TOTAL WOMEN’S CLOTHING $ __________
BOY’S CLOTHING
SHIRTS
Dress, Long Sleeve _____ 10.00 _____ 6.00 ___________
Short Sleeve _____ 8.00 _____ 5.00 ___________
Casual, Long Sleeve _____ 8.00 _____ 5.00 ___________
Short Sleeve _____ 10.00 _____ 7.00 ___________
Turtleneck _____ 6.00 _____ 4.00 ___________
Flannel, Long Sleeve _____ 7.00 _____ 4.00 ___________
Sport, Pullover, Long Slv _____ 12.00 _____ 8.00 ___________
Pullover, Short Slv _____ 8.00 _____ 6.00 ___________
SWEATERS, Dress or Casual
Pullover, Long Slv _____ 12.00 _____ 7.00 ___________
Vest _____ 8.00 _____ 5.00 ___________
(continued)
8
BOY’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Cardigan _____ 12.00 _____ 7.00 ___________
V-Neck _____ 8.00 _____ 5.00 ___________
SLACKS AND PANTS
Dress _____ 12.00 _____ 7.50 ___________
Casual Denim _____ 10.00 _____ 7.50 ___________
Corduroy _____ 8.00 _____ 6.00 ___________
Other _____ 8.00 _____ 6.00 ___________
SUMMERWEAR
Shorts, Denim _____ 7.00 _____ 4.50 ___________
Other _____ 6.00 _____ 4.00 ___________
Shirts, Tank _____ 4.00 _____ 3.00 ___________
T-Shirt _____ 6.00 _____ 4.00 ___________
Swimwear _____ 6.00 _____ 4.50 ___________
EXERCISE, Shirts
Fleece, Long Sleeve _____ 10.00 _____ 6.00 ___________
Fleece, Short Sleeve _____ 6.00 _____ 5.00 ___________
Pants, Fleece _____ 6.00 _____ 4.00 ___________
Nylon _____ 6.00 _____ 5.00 ___________
Shorts, Fleece _____ 4.00 _____ 3.50 ___________
Nylon _____ 8.00 _____ 4.00 ___________
Suits (matching Pants & Shirt)
Fleece _____ 14.00 _____ 8.00 ___________
Nylon _____ 18.00 _____ 10.00 ___________
Jackets, Fleece _____ 10.00 _____ 8.00 ___________
Nylon/Fleece
Insulated _____ 12.00 _____ 8.00 ___________
SUITS, Dress
Two Piece _____ 30.00 _____ 15.00 ___________
Coat _____ 16.00 _____ 10.00 ___________
Slacks _____ 10.00 _____ 8.00 ___________
Casual, Sport Coat _____ 22.00 _____ 12.00 ___________
UNDERGARMENTS
Shirt, Insulated, Long Slv _____ 3.00 _____ 1.50 ____________
T-Shirt _____ 2.00 _____ 1.00 ____________
Pants, Insulated _____ 2.00 _____ 1.00 ____________
Underwear, Regular _____ 1.00 _____ 0.75 ____________
Socks (pair), Dress _____ 2.00 _____ 1.00 ____________
Other _____ 1.00 _____ 0.75 ____________
(continued)
9
BOY’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
SLEEPWEAR
Pajamas, Matching Set _____ 6.00 _____ 4.50 ____________
Robe _____ 7.00 _____ 5.00 ____________
OUTERWEAR
Dress Winter Coat _____ 25.00 _____ 14.50 ____________
Casual Winter Coats,
Ski _____ 25.00 _____ 15.00 ____________
Casual, Jackets
Cloth _____ 15.00 _____ 10.00 ____________
Denim _____ 15.00 _____ 10.00 ____________
Vests, Winter _____ 12.00 _____ 6.00 ____________
Ski _____ 10.00 _____ 8.00 ____________
Mittens/Gloves _____ 4.00 _____ 3.00 ____________
SHOES AND BOOTS
Dress, Shoes with laces _____ 12.00 _____ 7.50 ____________
Shoes, Slip-on _____ 10.00 _____ 7.00 ____________
Casual- Shoes with laces _____ 10.00 _____ 6.50 ____________
Shoes, Slip-on _____ 10.00 _____ 6.00 ____________
Boots, Western _____ 14.00 _____ 8.00 ____________
Sport, Sneakers, Leather _____ 10.00 _____ 5.00 ____________
Sneakers, Cloth _____ 10.00 _____ 8.00 ____________
Miscellaneous:
Boots, Snow _____ 12.00 _____ 6.00 ____________
Slippers _____ 4.00 _____ 3.00 ____________
ACCESSORIES
Belts, Dress, Leather _____ 6.00 _____ 3.00 ____________
Other _____ 4.00 _____ 2.00 ____________
Suspenders
Button-on/Clip-on _____ 3.00 _____ 2.00 ____________
Caps, Baseball _____ 4.00 _____ 2.00 ____________
Sun Visor _____ 2.00 _____ 1.00 ____________
Stocking _____ 3.00 _____ 1.00 ____________
Scarves, Winter _____ 3.00 _____ 2.00 ____________
Ties _____ 3.00 _____ 2.00 ____________
TOTAL BOY’S CLOTHING $ __________
10
GIRL’S CLOTHING
EXCELLENT GOOD TOTAL
BLOUSES AND SHIRTS
Dress Long Sleeve _____ 12.00 _____ 7.00 ___________
Short Sleeve _____ 10.00 _____ 5.50 ___________
Casual, Long Sleeve _____ 12.00 _____ 7.50 ___________
Short Sleeve _____ 8.00 _____ 5.00 ___________
Turtleneck _____ 6.00 _____ 4.00 ___________
SWEATERS, DRESS OR CASUAL
Pullover, Long Slv _____ 13.00 _____ 9.00 ___________
Vest _____ 10.00 _____ 6.00 ___________
Cardigan _____ 12.00 _____ 8.00 ___________
V-Neck _____ 8.00 _____ 5.00 ___________
SLACKS AND PANTS
Dress _____ 12.00 _____ 8.00 ___________
Casual - Denim _____ 12.00 _____ 6.00 ___________
Corduroy _____ 9.00 _____ 6.00 ___________
Other _____ 8.00 _____ 5.00 ___________
DRESSES, Dress _____ 28.00 _____ 15.00 ___________
Casual _____ 22.00 _____ 12.00 ___________
Summer _____ 12.00 _____ 10.00 ___________
SKIRTS, Casual/Denim _____ 10.00 _____ 6.50 ___________
Casual/Other _____ 8.00 _____ 5.00 ___________
JUMPERS
Dress or Casual _____ 16.00 _____ 10.00 ___________
SUMMERWEAR
Shorts, Denim _____ 7.00 _____ 4.50 ___________
Other _____ 6.00 _____ 4.00 ___________
Tops, Tank _____ 6.00 _____ 3.00 ___________
T-Shirt _____ 8.00 _____ 4.50 ___________
Other _____ 6.00 _____ 3.50 ___________
Swimwear, One Piece _____ 8.00 _____ 5.00 ___________
Two Piece _____ 8.00 _____ 5.00 ___________
EXERCISE
Shirts, Sweatshirt, Long Slv _____ 12.00 _____ 6.00 ___________
Sweatshirt, Short Slv _____ 8.00 _____ 6.00 ___________
(continued)
11
GIRL’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Pants, Fleece _____ 6.00 _____ 4.00 ___________
Nylon _____ 7.00 _____ 5.00 ___________
Shorts, Fleece _____ 5.00 _____ 3.00 ___________
Nylon _____ 7.00 _____ 4.50 ___________
Suits (matching pants & shirts)
Fleece _____ 16.00 _____ 7.00 ___________
Nylon _____ 18.00 _____ 10.00 ___________
Jackets, Fleece w/Hood _____ 12.00 _____ 10.00 ___________
Fleece, Insulated _____ 10.00 _____ 8.00 ___________
Leotards _____ 7.00 _____ 4.00 ___________
UNDERGARMENTS
Panties, Regular _____ 2.00 _____ 1.00 ___________
Bikini _____ 2.00 _____ 1.00 ___________
Slips, Full _____ 4.00 _____ 3.00 ___________
Half _____ 4.00 _____ 3.00 ___________
Camisole _____ 4.00 _____ 3.00 ___________
Socks (pair), Dress _____ 2.00 _____ 1.00 ___________
Other _____ 2.00 _____ 1.00 ___________
SLEEPWEAR
Nightgown _____ 8.00 _____ 4.00 ___________
Pajamas _____ 8.00 _____ 5.00 ___________
Robe _____ 12.00 _____ 7.00 ___________
Night Shirt _____ 8.00 _____ 5.00 ___________
OUTERWEAR
Dress Winter Coats _____ 28.00 _____ 16.50 __________
Casual Winter Coats
Ski _____ 25.00 _____ 14.00 __________
Other _____ 20.00 _____ 12.00 __________
Dress Jackets _____ 24.00 _____ 15.50 __________
Casual Jackets, Cloth _____ 18.00 _____ 10.00 __________
Ear Muffs _____ 4.00 _____ 2.00 __________
Jackets, Other _____ 15.00 _____ 9.50 __________
Rainwear, Coat _____ 10.00 _____ 8.00 __________
Misc, Ski Bibs _____ 10.00 _____ 8.00 __________
SHOES AND BOOTS
Shoes with Laces _____ 11.00 _____ 7.00 __________
Shoes, Slip-on _____ 10.00 _____ 6.00 __________
Casual, Shoes with Laces _____ 10.00 _____ 6.50 __________
Shoes, Slip-on _____ 9.00 _____ 5.00 __________
(continued)
12
GIRL’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
Sport, Sneaker, Cloth _____ 8.00 _____ 5.00 __________
Sneaker, Leather _____ 10.00 _____ 8.00 __________
Miscellaneous:
Boots, Snow _____ 10.00 _____ 6.00 __________
Slippers _____ 4.00 _____ 3.00 __________
Sandals _____ 6.00 _____ 3.00 __________
ACCESSORIES
Belts, Leather _____ 7.00 _____ 4.00 __________
Other _____ 4.00 _____ 3.00 __________
Caps, Biking _____ 3.00 _____ 2.50 __________
Stocking _____ 3.00 _____ 2.00 __________
Scarves _____ 4.00 _____ 2.00 __________
Hats, Dress _____ 5.00 _____ 3.00 __________
Summer _____ 3.00 _____ 2.00 __________
Purses _____ 8.00 _____ 3.50 __________
TOTAL GIRL’S CLOTHING $ __________
TODDLER’S CLOTHING
SHIRTS AND BLOUSES
Long Sleeve _____ 10.00 _____ 5.00 ___________
Short Sleeve _____ 8.00 _____ 5.00 ___________
Turtleneck _____ 5.00 _____ 3.00 ___________
SWEATERS
Pullover, Long Sleeve _____ 10.00 _____ 5.00 ___________
Cardigan _____ 12.00 _____ 6.00 ___________
Vest _____ 7.00 _____ 4.00 ___________
PANTS, Denim _____ 8.00 _____ 5.50 ___________
Other _____ 7.00 _____ 5.00 ___________
SUITS, Dress _____ 20.00 _____ 12.50 ___________
SUMMERWEAR
Shirts, Tank Top _____ 3.00 _____ 2.00 ___________
T-Shirt _____ 5.00 _____ 3.00 ___________
Shorts, Denim _____ 6.00 _____ 4.00 ___________
Other _____ 5.00 _____ 3.00 ___________
(continued)
13
TODDLER’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
DRESSES, Dress _____ 24.00 _____ 10.00 ___________
Casual _____ 16.00 _____ 9.00 ___________
Skirts _____ 7.50 _____ 4.50 ___________
SLEEPWEAR
Pajamas _____ 6.00 _____ 4.00 ___________
Sleepers, With Feet _____ 6.00 _____ 4.00 ___________
Without Feet _____ 5.00 _____ 3.00 ___________
Gowns _____ 6.00 _____ 4.00 ___________
OUTERWEAR
Winter Coats, Dress _____ 30.00 _____ 15.00 ___________
Casual _____ 18.00 _____ 11.00 ___________
Jackets, Dress _____ 16.00 _____ 10.00 ___________
Casual _____ 14.00 _____ 9.50 ___________
Misc, Snowsuit _____ 18.00 _____ 10.00 ___________
Gloves/Mittens _____ 3.00 _____ 2.00 ___________
Cap _____ 4.00 _____ 2.00 ___________
Sweaters _____ 6.00 _____ 4.50 ___________
Bib Overalls, Denim _____ 10.00 _____ 7.00 ___________
Corduroy _____ 8.00 _____ 5.50 ___________
Other _____ 10.00 _____ 6.50 ___________
Rain Coat _____ 8.00 _____ 6.00 ___________
EXERCISE
Shirt, Sweatshirt _____ 6.00 _____ 4.00 ___________
Nylon _____ 5.00 _____ 4.00 ___________
Pants, Fleece _____ 5.00 _____ 3.00 ___________
Nylon _____ 5.00 _____ 3.00 ___________
Suits (matching pants/shirt)
Fleece _____ 12.00 _____ 6.00 ___________
Nylon _____ 12.00 _____ 8.00 ___________
Jacket, Fleece _____ 10.00 _____ 6.00 ___________
UNDERGARMENTS
Underwear _____ 1.50 _____ 1.00 ___________
Panties _____ 1.50 _____ 1.00 ___________
Plastic Pants _____ 1.50 _____ 1.00 ___________
Socks - Pair Dress _____ 2.00 _____ 1.00 ___________
Other _____ 2.00 _____ 1.00 ___________
Tights _____ 2.00 _____ 1.00 ___________
Swimsuit _____ 6.00 _____ 3.00 ___________
(continued)
14
TODDLER’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
SHOES AND BOOTS
Shoes, Leather _____ 10.00 _____ 6.00 ___________
Shoes, Other _____ 10.00 _____ 5.50 ___________
Sneakers _____ 8.00 _____ 6.00 ___________
Boots, Leather _____ 10.00 _____ 5.50 ___________
Boots, Snow _____ 6.00 _____ 4.00 ___________
Slippers _____ 4.00 _____ 3.00 ___________
TOTAL TODDLER’S CLOTHING $ __________
INFANT’S CLOTHING
SHIRTS, Long Sleeve _____ 8.00 _____ 4.00 ___________
Short Sleeve _____ 6.00 _____ 4.00 ___________
T-Shirt _____ 5.00 _____ 3.00 ___________
Tank Tops _____ 3.00 _____ 2.00 ___________
PANTS, Casual _____ 8.00 _____ 5.50 ___________
SWEATERS
Pullover, Long Slv _____ 10.00 _____ 5.00 ___________
Cardigan _____ 10.00 _____ 6.00 ___________
SHORTS, Dress or Casual _____ 5.00 _____ 3.50 ___________
PLAYSUITS, Casual _____ 12.00 _____ 8.00 ___________
DRESSES, Dress or Casual _____ 22.00 _____ 11.00 ___________
OUTERWEAR
Snowsuit _____ 20.00 _____ 11.00 ___________
Winter Coats _____ 18.00 _____ 10.00 ___________
Jackets _____ 14.00 _____ 7.50 ___________
Caps _____ 3.00 _____ 2.00 ___________
Gloves/Mittens _____ 2.00 _____ 1.50 ___________
Stocking Cap _____ 2.50 _____ 1.50 ___________
SLEEPWEAR
Sleeper with Feet _____ 6.00 _____ 4.00 ___________
Sleeper without Feet _____ 6.00 _____ 3.50 ___________
Gowns _____ 7.00 _____ 3.00 ___________
(continued)
15
INFANT’S CLOTHING (Continued)
EXCELLENT GOOD TOTAL
UNDERGARMENTS
Socks (pair) _____ 2.00 _____ 1.00 ___________
Tights _____ 2.00 _____ 1.00 ___________
Booties _____ 2.00 _____ 1.00 ___________
Swim Suits _____ 6.00 _____ 4.00 ___________
SHOES AND BOOTS
Dress or Casual _____ 10.00 _____ 4.00 ___________
MISCELLANEOUS
Bibs _____ 2.00 _____ 1.00 ___________
Changing Pad _____ 4.00 _____ 2.00 ___________
BEDDING
Blankets _____ 14.00 _____ 8.00 ___________
Afghan _____ 15.00 _____ 6.50 ___________
Quilt _____ 22.00 _____ 13.00 ___________
Sheet (set) _____ 8.00 _____ 5.00 ___________
Pillow _____ 5.00 _____ 3.00 ___________
Receiving Blanket _____ 4.00 _____ 2.50 ___________
TOTAL INFANTS’S CLOTHING $ __________
HOUSEHOLD GOODS
BOOKS & MUSIC
Cassettes _____ 3.00 _____ 1.00 __________
Compact Discs _____ 4.00 _____ 3.00 __________
Cookbook _____ 6.50 _____ 3.00 __________
Encyclopedia Set _____ 35.00 _____ 20.00 __________
Games, Board _____ 4.00 _____ 2.50 __________
Book, Hardback _____ 6.00 _____ 3.00 __________
Magazine _____ 0.50 _____ 0.40 __________
Paperback Book _____ 2.00 _____ 1.00 __________
Puzzles _____ 2.00 _____ 1.00 __________
Record Album _____ 2.00 _____ 1.00 __________
Records, 45s _____ 1.00 _____ 0.50 __________
Video Game Cartridges _____ 5.00 _____ 3.00 __________
(continued)
16
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
ELECTRIC APPLIANCE, SMALL
Answering Machine _____ 14.00 _____ 7.00 ___________
Blender _____ 10.00 _____ 8.50 ___________
Burger Maker _____ 5.00 _____ 4.00 ___________
Can Opener _____ 7.00 _____ 5.00 ___________
Clock Radio _____ 10.00 _____ 6.00 ___________
Coffee Maker _____ 15.00 _____ 10.00 ___________
Coffee Pot _____ 10.00 _____ 8.00 ___________
Crock Pot _____ 10.00 _____ 7.00 ___________
Curling Iron _____ 4.00 _____ 3.00 ___________
Food Processor _____ 18.00 _____ 14.00 ___________
Hair Dryer, Blow _____ 7.00 _____ 5.00 ___________
Heater, Room _____ 16.00 _____ 14.00 ___________
Iron _____ 8.00 _____ 5.00 ___________
Ironing Board _____ 8.00 _____ 5.00 ___________
Kitchen Clock _____ 10.00 _____ 8.00 ___________
Knife, Electric _____ 6.00 _____ 5.00 ___________
Mixer, Hand Electric _____ 8.00 _____ 6.00 ___________
Pasta Maker _____ 10.00 _____ 8.00 ___________
Popcorn Popper _____ 7.00 _____ 5.00 ___________
Record Player _____ 25.00 _____ 14.00 ___________
Rug Shampooer _____ 30.00 _____ 20.00 ___________
Shop-Vac _____ 25.00 _____ 18.00 ___________
Skillet-Electric _____ 12.00 _____ 9.00 ___________
Tape Recorder _____ 14.00 _____ 7.00 ___________
Telephone _____ 14.00 _____ 8.00 ___________
Toaster _____ 8.00 _____ 6.00 ___________
Vacuum, Canister _____ 20.00 _____ 14.00 ___________
Vacuum, Hand Held _____ 10.00 _____ 6.50 ___________
Vacuum, Upright _____ 45.00 _____ 24.00 ___________
Vaporizer _____ 8.00 _____ 5.00 ___________
Video Cassette Recorder _____ 42.00 _____ 32.00 ___________
ELECTRIC APPLIANCES, MAJOR
Air Conditioner _____ 125.00 _____ 80.00 ___________
Dishwasher _____ 120.00 _____ 67.50 ___________
Dryer _____ 125.00 _____ 95.00 ___________
Freezer, Chest _____ 150.00 _____ 100.00 ___________
Freezer, Upright _____ 150.00 _____ 110.00 ___________
Humidifier _____ 30.00 _____ 10.00 ___________
Jenn-Air _____ 310.00 _____ 180.00 ___________
Microwave, Apartment _____ 60.00 _____ 45.00 ___________
Microwave, Standard _____ 70.00 _____ 47.50 ___________
Oven, Wall _____ 75.00 _____ 67.50 ___________
Range, Double Oven _____ 180.00 _____ 132.50 ___________
(continued)
17
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
Range, Oven/Micro _____ 190.00 _____ 115.00 ___________
Refrigerator _____ 150.00 _____ 75.00 ___________
Stove, Electric _____ 150.00 _____ 110.00 ___________
Stove, Gas _____ 125.00 _____ 75.00 ___________
Washer _____ 100.00 _____ 70.00 ___________
Washer/Dryer Set _____ 300.00 _____ 187.50 ___________
SPORTS EQUIPMENT
Bar Bells w/Weights _____ 50.00 _____ 20.00 ___________
Baseball _____ 2.00 _____ 1.50 ___________
Basketball _____ 12.00 _____ 5.00 ___________
Bike _____ 225.00 _____ 68.00 ___________
Bike Carrier _____ 50.00 _____ 23.00 ___________
Bowling Bag _____ 5.00 _____ 3.00 ___________
Bowling Ball _____ 6.00 _____ 3.00 ___________
Bowling Shoes _____ 16.00 _____ 15.00 ___________
Exercise Bike, Computer _____ 220.00 _____ 65.00 ___________
Exercise Bike, Manual _____ 60.00 _____ 22.50 ___________
Football _____ 6.00 _____ 4.00 ___________
Football, Helmet _____ 12.00 _____ 8.00 ___________
Football, Shoes _____ 15.00 _____ 10.00 ___________
Frisbees _____ 1.00 _____ 0.50 ___________
Glove, Catcher _____ 42.00 _____ 21.50 ___________
Gloves, Boxing _____ 18.00 _____ 10.00 ___________
Golf , Old 8 Piece Set _____ 180.00 _____ 72.50 ___________
Golf , Bag _____ 75.00 _____ 40.00 ___________
Golf , Club Cover Set _____ 8.00 _____ 6.00 ___________
Golf , Iron _____ 14.00 _____ 5.00 ___________
Golf , Pull Cart _____ 20.00 _____ 14.00 ___________
Golf , Putter _____ 34.00 _____ 12.00 ___________
Golf , Shoes _____ 18.00 _____ 10.00 ___________
Golf , Woods _____ 30.00 _____ 20.00 ___________
Ice Skates, Adult _____ 42.00 _____ 28.00 ___________
Ice Skates, Child _____ 15.00 _____ 10.00 ___________
Nordic Trak _____ 260.00 _____ 122.50 ___________
Roller Blades, Adult _____ 42.00 _____ 24.00 ___________
Roller Blades, Child _____ 20.00 _____ 14.00 ___________
Roller Skates _____ 15.00 _____ 8.00 ___________
Rowing Machine _____ 75.00 _____ 60.00 ___________
Skate, Board _____ 45.00 _____ 20.00 ___________
Skate, Knee Pads _____ 10.00 _____ 8.00 ___________
Ski, Water Knee Board _____ 65.00 _____ 40.00 ___________
Ski, Water (pair) _____ 115.00 _____ 51.50 ___________
(continued)
18
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
Ski, Water Slalom _____ 60.00 _____ 40.00 ___________
Ski Board, Snow _____ 65.00 _____ 25.00 ___________
Ski Boot Carrier _____ 10.00 _____ 8.00 ___________
Ski Boots, Adult _____ 40.00 _____ 24.00 ___________
Ski Boots, Child _____ 30.00 _____ 12.00 ___________
Ski Glider _____ 60.00 _____ 50.00 ___________
Ski Poles _____ 15.00 _____ 10.00 ___________
Sleeping Bag _____ 7.00 _____ 5.50 ___________
Skis, Snow _____ 120.00 _____ 60.00 ___________
Stairmaster, Computer _____ 130.00 _____ 75.00 ___________
Stairmaster, Manual _____ 75.00 _____ 45.00 ___________
Tredmill, Computer _____ 225.00 _____ 120.00 ___________
Weight Bench _____ 50.00 _____ 35.00 ___________
LINENS
Apron _____ 4.00 _____ 3.00 ___________
Bath Towels _____ 4.00 _____ 2.00 ___________
Bedspread _____ 30.00 _____ 14.50 ___________
Blanket _____ 12.00 _____ 7.00 ___________
Comforter _____ 35.00 _____ 18.00 ___________
Dish Towel _____ 2.00 _____ 1.00 ___________
Pillow Sham _____ 5.00 _____ 2.00 ___________
Pillow Case Set _____ 9.00 _____ 3.50 ___________
Pillows _____ 3.00 _____ 2.00 ___________
Place Mats, Set _____ 6.00 _____ 4.00 ___________
Quilt _____ 28.00 _____ 12.00 ___________
Sheet Sets _____ 12.00 _____ 8.00 ___________
Table Cloth _____ 14.00 _____ 7.00 ___________
Throw Pillows _____ 10.00 _____ 6.00 ___________
Throw Rug _____ 10.00 _____ 5.00 ___________
Wash Cloth _____ 1.00 _____ 1.00 ___________
Air Purifier _____ 14.00 _____ 8.00 ___________
Bean Bag Chair _____ 6.00 _____ 4.00 ___________
Bed, Roll Away _____ 27.00 _____ 15.00 ___________
Bookshelf _____ 120.00 _____ 60.00 ___________
Box Springs _____ 30.00 _____ 10.00 ___________
Brass Fireplace Tools _____ 25.00 _____ 15.00 ___________
Buffet _____ 275.00 _____ 175.00 ___________
Bunk Beds _____ 130.00 _____ 90.00 ___________
Card Table & Chairs _____ 30.00 _____ 20.00 ___________
Chair, Folding Lawn _____ 6.00 _____ 5.00 ___________
Chair, Living Room _____ 125.00 _____ 50.00 ___________
Chair, Lounge _____ 80.00 _____ 60.00 ___________
Chair, Office _____ 65.00 _____ 37.50 ___________
(continued)
19
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
Chair, Secretary _____ 55.00 _____ 30.00 ___________
Chest of Drawers _____ 200.00 _____ 100.00 ___________
Coat Rack _____ 50.00 _____ 20.00 ___________
Curio _____ 325.00 _____ 165.00 ___________
De-Humidifier _____ 20.00 _____ 14.00 ___________
Desk, Bedroom _____ 160.00 _____ 120.00 ___________
Desk, Child _____ 85.00 _____ 40.00 ___________
Desk, Office Wood _____ 175.00 _____ 95.00 ___________
FURNITURE
Desk, Wicker _____ 120.00 _____ 75.00 ___________
Dining Room Set _____ 420.00 _____ 125.00 ___________
Dresser _____ 225.00 _____ 125.00 ___________
Dresser w/Mirror _____ 300.00 _____ 180.00 ___________
Entertainment Center _____ 320.00 _____ 122.50 ___________
Headboard, Twin _____ 80.00 _____ 42.50 ___________
Headboard, Full _____ 120.00 _____ 60.00 ___________
Headboard, Queen _____ 120.00 _____ 60.00 ___________
Headboard, King _____ 125.00 _____ 70.00 ___________
Humidifier _____ 14.00 _____ 8.00 ___________
Hutch, Solid Wood _____ 325.00 _____ 160.00 ___________
Lamp, Desk _____ 45.00 _____ 20.00 ___________
Lamp, Floor _____ 125.00 _____ 50.00 ___________
Lamp, Swag _____ 50.00 _____ 25.00 ___________
Lamp, Table _____ 100.00 _____ 35.00 ___________
Lamp, Shades _____ 8.00 _____ 6.00 ___________
Mattress, Twin _____ 60.00 _____ 45.00 ___________
Mattress, Full _____ 75.00 _____ 60.00 ___________
Mattress, Queen _____ 75.00 _____ 60.00 ___________
Mattress, King _____ 80.00 _____ 75.00 ___________
Nightstand _____ 100.00 _____ 37.50 ___________
Piano _____ 350.00 _____ 225.00 ___________
Rack, Magazine _____ 20.00 _____ 15.00 ___________
Recliner _____ 140.00 _____ 72.50 ___________
Rocker, Swivel _____ 75.00 _____ 40.00 ___________
Rocker, Wood _____ 120.00 _____ 60.00 ___________
Sectional _____ 250.00 _____ 150.00 ___________
Sewing Machine _____ 60.00 _____ 35.00 ___________
Sofa, 3 Piece Set _____ 800.00 _____ 310.00 ___________
Sofa, Love Seat _____ 450.00 _____ 165.00 ___________
Sofa, Regular _____ 210.00 _____ 145.00 ___________
Sofa with Sleeper _____ 200.00 _____ 137.50 ___________
(continued)
20
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
Sofa with Recliner _____ 240.00 _____ 180.00 ___________
Space Heater _____ 10.00 _____ 7.50 ___________
Stools, Set of 4 _____ 125.00 _____ 77.50 ___________
Table, Coffee _____ 100.00 _____ 50.00 ___________
Table, Dining _____ 160.00 _____ 95.00 ___________
Table, with Chairs _____ 350.00 _____ 162.50 ___________
Table, End _____ 95.00 _____ 40.00 ___________
Table, Hall with Mirror _____ 200.00 _____ 145.00 ___________
Table, Kitchen _____ 125.00 _____ 67.50 ___________
Typewriter, Electric _____ 60.00 _____ 24.00 ___________
Typewriter, Manual _____ 20.00 _____ 10.00 ___________
TV, Black/White _____ 30.00 _____ 20.00 ___________
TV, Color Console _____ 130.00 _____ 60.00 ___________
TV, Portable _____ 120.00 _____ 50.00 ___________
Vanity and Stool _____ 150.00 _____ 100.00 ___________
KITCHEN MISCELLANEOUS
Coffee Mugs _____ 2.00 _____ 1.00 ___________
Cutting Board _____ 4.00 _____ 2.50 ___________
Designer Plates _____ 22.00 _____ 10.00 ___________
Glassware Tumbler _____ 3.00 _____ 1.00 ___________
Hot Pad _____ 3.00 _____ 2.00 ___________
Pots and Pans _____ 18.00 _____ 5.50 ___________
Plates, Dinner _____ 2.00 _____ 1.00 ___________
Shakers, Salt/Pepper _____ 5.00 _____ 2.00 ___________
Teapot _____ 6.00 _____ 4.00 ___________
Tupperware _____ 3.00 _____ 1.00 ___________
BATHROOM ACCESSORIES
Bathroom Scale _____ 5.00 _____ 3.50 ___________
Shower Curtain _____ 5.00 _____ 3.00 ___________
Toilet Floor Mat _____ 3.00 _____ 2.00 ___________
Toilet Tank Cover _____ 2.00 _____ 1.00 ___________
Toilet Seat Cover _____ 2.00 _____ 1.50 ___________
CHILDREN’S ACCESSORIES
Animal, Large Stuffed _____ 6.00 _____ 4.00 ___________
Animal, Small Stuffed _____ 6.00 _____ 4.00 ___________
Baby Bumper Pads _____ 15.00 _____ 9.00 ___________
Baby Street Seat _____ 35.00 _____ 21.00 ___________
Baby Carrier _____ 20.00 _____ 13.00 ___________
Baby Changing Table _____ 50.00 _____ 28.00 ___________
(continued)
21
HOUSEHOLD GOODS (Continued)
EXCELLENT GOOD TOTAL
Baby Crib _____ 138.00 _____ 65.00 ___________
Baby Playpen _____ 38.00 _____ 25.00 ___________
Baby Potty Chair _____ 7.00 _____ 5.00 ___________
Baby Scooter _____ 12.50 _____ 10.00 ___________
Baby Sling _____ 10.00 _____ 6.00 ___________
Baby Stroller _____ 45.00 _____ 28.00 ___________
Baby Swing _____ 20.00 _____ 15.00 ___________
Baby Tub _____ 6.00 _____ 4.00 ___________
Baby Walker _____ 20.00 _____ 14.00 ___________
Booster Seat _____ 7.00 _____ 5.00 ___________
Diaper Bag _____ 8.00 _____ 6.00 ___________
Dolls _____ 8.00 _____ 4.00 ___________
High Chair _____ 25.00 _____ 14.00 ___________
Johnny Jump-Up _____ 10.00 _____ 8.00 ___________
Room Monitor _____ 15.00 _____ 12.00 ___________
Tricycle _____ 10.00 _____ 9.00 ___________
MISCELLANEOUS
Afghan _____ 10.00 _____ 7.00 ___________
Ash Trays _____ 2.00 _____ 0.50 ___________
Bedroom Curtains _____ 18.00 _____ 11.00 ___________
Blanket, Heating _____ 8.00 _____ 6.00 ___________
Camera _____ 14.00 _____ 6.00 ___________
Carry-on Bag _____ 20.00 _____ 12.00 ___________
Crutches _____ 5.00 _____ 3.00 ___________
Dining Room Drapes _____ 28.00 _____ 15.00 ___________
Doormat _____ 5.00 _____ 3.00 ___________
Eyeglasses _____ 6.00 _____ 3.00 ___________
Flashlight _____ 4.00 _____ 3.00 ___________
Flower Pot _____ 2.50 _____ 1.00 ___________
Flower Vase _____ 10.00 _____ 4.00 ___________
Glass Candle Holder _____ 6.00 _____ 4.00 ___________
Heating Pad _____ 4.00 _____ 3.00 ___________
Lawn Mower _____ 70.00 _____ 45.00 ___________
Luggage, Set _____ 50.00 _____ 24.00 ___________
Mini Blinds _____ 8.00 _____ 6.00 ___________
Patterns _____ 1.00 _____ 0.75 ___________
Picture Frames _____ 8.00 _____ 6.00 ___________
Straw Basket _____ 4.00 _____ 3.00 ___________
Suitcase, Individual _____ 10.00 _____ 5.00 ___________
HOUSEHOLD GOODS TOTAL $ _________
22