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PERSONAL PROPERTY INVENTORY (PDF)

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					PERSONAL PROPERTY INVENTORY
NAME ADDRESS

LIVING AREAS
Carpets, rugs Draperies Curtains Sofas/Sectionals Studio Couches Lounge Chairs Occasional Chairs Straight Chairs Slip Covers Pillows Tables Table Accessories Desks Coffee Table Desk Accessories Room Dividers Planters Lamps Pictures Wall Hangings Mirrors Décor Clocks Fireside Fixtures TV Tables

1. ___________________ Original Present No. Cost Value

No.

2. ___________________ Original Present Cost Value

3. ___________________ Original Present No. Cost Value

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

BEDROOMS
Carpets, rugs Draperies Curtains Beds, Springs Mattresses Dressers Chests Vanities Chaise Lounges Chairs Benches Tables Night Stands Desks Secretaries Lamps Pictures Wall Hangings Mirrors Décor Baby Cribs Playpens Bassinets Bathinets Nursery Clocks Accessories

1. ___________________ Original Present No. Cost Value

No.

2. ___________________ Original Present Cost Value

3. ___________________ Original Present No. Cost Value

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

DINING AREA
Buffet, credenza Carpets, rugs China cabinet, hutch Clocks Coffee Table Coffee Table Curtains Décor Desk accessories Desks Desks Draperies Fireside Fixtures Lamps Lounge Chairs Mirrors Occasional charis Pictures Pillows Planters Room dividers Serving Tables Slip Covers Snak bar stools Sofas/Sectionals Straight Chairs Studio Couches Table accessories Tables TV Tables Wall Hangings

No.

Original Cost

Present Value

Remarks

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

PERSONAL EFFECTS No.
Beachwear Belts Billfolds Boots Electric razor Formal attire Gloves Handkerchiefs Hats, caps Jeans Lighters, cases Luggage Men's jewelry Overcoats Pajamas Robes Shirts Shoes, loafers Shorts Slacks Slippers Socks Sports coats Sports jackets Sportswear Suits Sweaters Sweatshirts Ties Topcoats Underwear

Men's Original Cost

Present Value

No.

Boy's Original Cost

Present Value

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

PERSONAL EFFECTS No.
Beachwear Belts Blouses Coats Cosmetics Costume jewelry Day dresses formals Galoshes, boots Hair Dryers handercheifs Hats, gloves Hosiery, scarves Housecoats Jackets Lingerie Luggage Party dresses Purses, billfolds Robes Shoes, slippers Shorts Skirts Slacks, Jeans Sleepwear Socks Sprotswear Suits Sweaters Sweatshirts / pants Umbrellas Underwear

Women's Original Cost

Present Value

No.

Girls' Original Cost

Present Value

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

JEWELRY
Braclets Earrings Necklaces, chokers Pendants Pins, Brooches Rings Watches

No.

Original Cost

Present Value

DESCRIPTION

TOTALS

FURS Capes Coats Jackets Scarves Stoles TOTAL

No.

Original Cost

Present Value

DESCRIPTION

FINE ARTS Etchings Figurines Other Art Paintings Statuary

No.

Original Cost

Present Value

DESCRIPTION

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

CHINA, LINENS
China, Dinnerware China Bowls Breakfast Sets Luncheon Sets

No.

Original Cost

Present Value

DESCRIPTION

Table Cloths Napkins Placemats TOTALS

CRYSTAL
Goblets Glasses, tumblers Sherbet, parfait Punch bowel set Cocktail glasses Liqueur glasses Pitchers Decanters Bowls, vases Dishes TOTAL

No.

Original Cost

Present Value

DESCRIPTION

SILVER
Place settings Serving pieces Platters, trays Dishes, bowls Chafing dishes Tea service Pitchers Candleholders Other pieces

No.

Original Cost

Present Value

DESCRIPTION

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

RECREATION
CD Players CD/Cassettes DVD Players DVD's Musical Instruments Organs Pianos Radios Stereo Tape Recorders Televisions Sets VCR Video's Walkman

No.

Original Cost

Present Value

DESCRIPTION

TOTALS

LEISURE
Archery sets Art supplies Bicycles Billard tables Boats, Motors Bowling equipment Camera Equipment Camping Equipment Card tables Chairs Coin collections Fishing Tackle Games Golf Clubs Guns, Firearms Hand tools Ice Skates Ping pong table Playground equipment Power Tools Ski equipment Stamp collections Tennis equipment Toys Other Equipment

No.

Original Cost

Present Value

DESCRIPTION

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

KITCHEN
Clocks Cookware Crockpot Cutlery Décor Dish washer Dishes Foods Freezer Kitchen chairs Kitchen table Liquors, wines Microwave Refrigeratior Stoves Utensils

No.

Original Cost

Present Value

DESCRIPTION

TOTALS

UTILITY
Cleaning supplies Clothes dryer Clothes washers Floor polishers Iron Iron board Rug shampooers Sewing machine Vacuum cleaners

No.

Original Cost

Present Value

Description

TOTAL

Appliances on next page.

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

APPLIANCES
Can openers Cappuccino Coffee makers Crockpots Electric toothbrushes Fry pans Grills, griddles Knives Mixers, blenders Roasters Rotisseries Sharpeners Toasters Waffle Iron

No.

Original Cost

Present Value

Description

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

BEDDING
Blankets, spreads Electric blankets Mattress pads Pillow cases Pillows Quilts Sheets

No.

Original Cost

Present Value

DESCRIPTION

TOTALS

BATHROOMS
Bath towels Bath accessories Bath mats Bath scales Carpets, rugs Cloths hampers Draperies, curtains Wash cloths

No.

Original Cost

Present Value

Description

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

YARD
Cooking equipment Edgers, trimmers Garden equipment Garden hose Lawn sweepers Outdoor furniture Pool accessories Power mowers Snow blowers Spreaders Sprinklers Tillers

No.

Original Cost

Present Value

DESCRIPTION

TOTALS

MISCELLANEOUS
Air conditioners Calculators Computer/Printers De-humidifiers Fans, heaters Humidifiers Typewriters

No.

Original Cost

Present Value

Description

TOTAL

BOOKS

No.

Original Cost

Present Value

Description

TOTAL

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

SUMMARY OF PERSONAL PROPERTY INVENTORY
See Page
LIVING AREAS 1 2 3 DINING AREAS BEDROOMS 1 2 3 4 5 PERSONAL EFFECTS Men's Boy's Women's Girl's JEWELRY CHINA, LINENS CRYSTAL FURS FINE ART SILVER RECREATION LEISURE KITCHEN YARD UTILITY APPLIANCES BEDDING BATHROOMS BOOKS MISCELLANEOUS TOTALS

Original Cost

Present Value

Comments

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001

PERSONAL PROPERTY INVENTORY
NAME ADDRESS

SUMMARY OF INVENTORY
Dwelling (Year built) Present cost to build (excluding foundation) Less ________% depreciation Present sound value Garage, Other Buildings (Year built) Present cost to build (excluding foundation) Less ________% depreciation Present sound value

Recommendation: Supplementing the Personal Property Inventory with a photo or video record of room contents, plus bills of sale, receipts and appraisals of items of special value provides documentation to establish losses with the greatest possible accuracy.

HEARTLAND MUTUAL INSURANCE ASSOCIATION PO BOX 918 FORT DODGE, IA 50501

9/20/2001


				
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