Home Inventory Checklist

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In the event of a fire or earthquake would you be able to remember all the items you have
lost?

If your home was robbed would you be able to

            List all of the valuable items that were taken from your home?
            Remember the serial numbers of your serialized items?

Do you know if your home is underinsured?

Completing a home inventory now will help you twofold by:

      Assisting you in determining if you have purchased adequate insurance to
       cover your valuable items. Unless you’ve updated your policy to reflect current
       market values, chances are your home and belongings are underinsured.
       Determining your home’s current value will assist you in deciding whether or not
       you need to obtain additional insurance.

      Protecting you in the event of a loss. Your inventory will provide a handy
       record of your belongings and simplify the claim-filing process. Include
       photographs of each room and its contents to further help you in determining
       which items are missing or destroyed in the event of a loss. Videotapes are also
       useful.


How to Determine the Value of Your Items:

In the event of a loss, Mid-State Mutual will replace your items based on the fair market
value. When completing this inventory, use the value of the items in today’s market.
Wherever necessary, attach lists to your inventory in order to itemize values.


How to Protect Your Home Inventory Records:

Print a copy of your inventory record and remember to store it in a safe location, such as
a safe deposit box.
\

                         Home Inventory Checklist



      Name
     Address


      City                       State              Zip

       Lot                       Block          Section




    Date of Original Inventory

       Revised

       Revised

       Revised




2/26/2010                                                 Page 2 of 27
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                         Home Inventory Checklist


Home Information

Year Built:                                Builder:

Sq. Footage: House                            Lot

Purchase Date:                               Price

Previous Owners:

Mortgage Holder:

Location of Plot Plan:

Loc. of Deed of Trust:

Loc. of Insurance
Policies:


Insurance Companies

Homeowners:

Earthquake:                                Mortgage:

Flood:                                       Fire:


Appraisals

Amount:                                      Year:

Amount:                                      Year:

Amount:                                      Year:

Amount:                                      Year:




2/26/2010                                              Page 3 of 27
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                        Home Inventory Checklist

                                            LIVING ROOM
    # OF                             ITEM                 Year Purchased       $$
            Bookcases
            Books
            Cabinets & Contents (attach list)                              .

            Ceiling Fan
.           Chairs                                                         .

            Clocks
            Closet Contents (attach list)                                  .


            Computer
.           Desk                                                           .

            Drapes                                                         .


            Electronic Games (Attach list)
            Entertainment Center
            Fireplace Equipment

            Games/Toys (Attach list)
.           Lamps                                                          .

            Piano or other instrument
.           Pictures                                                       .

.           Rugs                                                           .

.           Sofa                                                           .


            Software (Attach list)
.           Stereo Equipment                                               .

.           Tables                                                         .

            Telephone
.           TV                                                             .

            Wall Shelves                                                   .

            Window Air Conditioning Unit                                   .
.           Additional Items
.                                                                          .




.                                                                          .
            Total

2/26/2010                                                              Page 4 of 27
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                       Home Inventory Checklist


                                         Dining Room
    # OF                          ITEM                 Year Purchased       $$

            Buffet                                                      .
.                                                                       .
            Cabinets and Contents (Attach list)
            Ceiling Fan
            Chairs
.                                                                       .
            China
            Clocks
.                                                                       .
            Crystal
.                                                                       .
            Drapes
            Entertainment Center
                                                                        .
            Lamps
            Linens
            Mirror
.                                                                       .
            Pictures
.                                                                       .
            Rugs
.                                                                       .
            Silverware/Goldware
.                                                                       .
            Table Linens
            Tables
.                                                                       .
            Wall Shelves
                                                                        .
            Window Air Conditioning Unit
.                                                                       .
            Additional Items




.                                                                       .
            Total




2/26/2010                                                           Page 5 of 27
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                        Home Inventory Checklist

                                            Kitchen
    # OF                         ITEM                 Year Purchased         $$

            Cabinets & Contents (Attach list)
            Ceiling Fan
.                                                                       .
            Chairs
            Clocks
            Closet Contents (Attach list)
            Cookbooks                                                   .
                                                                        .
            Crystal
.                                                                       .
            Cutlery
.                                                                       .
            Dishwasher
                                                                        .
            Foods
.                                                                       .
            Freezer
            Garbage Disposal
                                                                        .
            Glassware
.                                                                       .
            Linens
            Liquors
.                                                                       .
            Microwave
                                                                        .
            Pots & Pans
.                                                                       .
            Refrigerator
.                                                                       .
            Small Appliances
            Stove/Oven
.                                                                       .
            Tables
            Telephone
            Trash Compactor
.                                                                       .
            Utensils
.                                                                       .
            Additional Items
            .




.                                                                       .
            Total


2/26/2010                                                              Page 6 of 27
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                       Home Inventory Checklist

                                        Laundry Room
    # OF                         ITEM                  Year Purchased         $$
            Cabinets & Contents (Attach list)
            Closet Contents (Attach list)
.           Dryer                                                        .

            Iron                                                         .

            Ironing Board                                                .
            Washing Machine                                              .

            Additional Items                                             .




.                                                                        .
            Total




2/26/2010                                                               Page 7 of 27
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                        Home Inventory Checklist

                                       Family Room/Den
    # OF                          ITEM                   Year Purchased         $$

            Bookcases
.                                                                          .
            Books
            Cabinets & Contents (Attach list)
.                                                                          .
            CD’s, etc. (Attach list)
            Ceiling Fan
            Chairs
            Clocks
            Closet Contents (Attach list)
            Computer
            Couches
                                                                           .
            Dehumidifier
            Desk
                                                                           .
            Desk
                                                                           .
            Drapes
            Electronic Games
            Entertainment Center
            Fireplace Equipment
            Games/Toys
.                                                                          .
            Hobby Equipment (Attach list)
                                                                           .
            Lamps
            Piano or other instruments (Attach list)
.                                                                          .
            Pictures
.                                                                          .
            Rugs
.                                                                          .
            Sewing Machine
            Sofa                                                           .

            Software
.                                                                          .
            Stereo
            Tables
            Telephone
.                                                                          .
            TV/VCR/DVD
            Typewriter

2/26/2010                                                                 Page 8 of 27
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                      Home Inventory Checklist
                                  Family Room/Den
    # OF                       ITEM                 Year Purchased         $$

            Wall shelves
            Window Air Conditioning Unit
            Additional Items




            Total




2/26/2010                                                            Page 9 of 27
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                      Home Inventory Checklist

                                      st
                                      1 Bathroom
    # OF                       ITEM                Year Purchased       $$
            Chair
.           Electric Razors                                         .

            Hair Dryers                                             .

            Hamper                                                  .

            Linens                                                  .

            Medicine Cabinet
.           Mirrors                                                 .


            Other
            Rugs
            Scale
            Table                                                   .
.           Additional Items
.                                                                   .



.                                                                   .




.                                                                   .
            Total




2/26/2010                                                      Page 10 of 27
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                      Home Inventory Checklist

                                      nd
                                      2    Bathroom
    # OF                       ITEM                   Year Purchased       $$
            Chair
.           Electric Razors                                            .

            Hair Dryers                                                .

            Hamper                                                     .

            Linens                                                     .

            Medicine Cabinet
.           Mirrors                                                    .

            Rugs
            Scale
            Table                                                      .

            Additional Items
.

.                                                                      .



.                                                                      .




.                                                                      .
            Total




2/26/2010                                                         Page 11 of 27
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                       Home Inventory Checklist

                                      Master Bedroom
    # OF                         ITEM                  Year Purchased          $$

            Bedding
            Beds
.                                                                         .
            Books
.                                                                         .
            Bookshelves
.                                                                         .
            Cabinets & Contents (Attach list)
            CD’s
            Chairs
.                                                                         .
            Chests & Contents (Attach list)
                                                                          .
            Child's Clothing
            Clocks
            Closet Contents (Attach list)
            Computer
.                                                                         .
            Desks
            Drapes
            Dressers & Contents (Attach list)                             .
.                                                                         .
            Dressing Table
            Electronic Games
            Entertainment Center
            Fitness Equipment
            Games/Toys
.                                                                         .
            Lamps
            Men's Clothing
            Mirrors
.                                                                         .
            Additional Items
            Pictures
                                                                          .
            Radios
            Rugs
.                                                                         .
            Sewing Machine
            Software
            Stereo
            Tables

2/26/2010                                                               Page 12 of 27
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                         Home Inventory Checklist
                                  Master Bedroom
    # OF                       ITEM                Year Purchased          $$

            Tables
            Telephone
                                                                      .
            Toiletries
            TV
.                                                                     .
            Wall Shelves
.                                                                     .
            Women's Clothing
            Additional Items




            Total




2/26/2010                                                           Page 13 of 27
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                       Home Inventory Checklist

                                         nd
                                        2     Bedroom
    # OF                        ITEM                    Year Purchased          $$

            Bedding
            Beds
.                                                                          .
            Books
.                                                                          .
            Bookshelves
.                                                                          .
            Cabinets & Contents (Attach list)
            CD’s
            Chairs
.                                                                          .
            Chests & Contents (Attach list)
                                                                           .
            Child’s Clothing
            Clocks
            Closet Contents
            Computer
.                                                                          .
            Desks
            Drapes
            Dressers & Contents (Attach list)                              .
.                                                                          .
            Dressing Table
            Electronic Games
            Entertainment Center
            Fitness Equipment
            Games/Toys
.                                                                          .
            Lamps
            Men’s Clothing
            Mirrors
            Pictures
                                                                           .
            Radios
            Rugs
.                                                                          .
            Sewing Machine
            Software
            Stereo
            Tables
            Tables

2/26/2010                                                                Page 14 of 27
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                         Home Inventory Checklist
                                      nd
                                      2    Bedroom
    # OF                       ITEM                  Year Purchased          $$

            Telephone
                                                                        .
            Toiletries
            TV
.                                                                       .
            Wall Shelves
.                                                                       .
            Women’s Clothing
.                                                                       .
            Additional Items




            Total




2/26/2010                                                             Page 15 of 27
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                       Home Inventory Checklist

                                            rd
                                            3 Bedroom
    # OF                          ITEM                  Year Purchased          $$

            Bedding
            Beds
.                                                                          .
            Books
.                                                                          .
            Bookshelves
.                                                                          .
            Cabinets & Contents (Attach list)
            CD’s
            Chairs
.                                                                          .
            Chests & Contents (Attach list)
                                                                           .
            Child’s Clothing
            Clocks
            Closet Contents (Attach list)
            Computer
.                                                                          .
            Desks
            Drapes
            Dressers & Contents                                            .
.                                                                          .
            Dressing Table
            Electronic Games
            Entertainment Center
            Fitness Equipment
            Games/Toys
.                                                                          .
            Lamps
            Men’s Clothing
            Mirrors
            Pictures
                                                                           .
            Radios
            Rugs
.                                                                          .
            Sewing Machine
            Software
            Stereo
            Tables
            Tables

2/26/2010                                                                Page 16 of 27
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                         Home Inventory Checklist
                                      rd
                                      3 Bedroom
    # OF                       ITEM               Year Purchased          $$

            Telephone
                                                                     .
            Toiletries
            TV
.                                                                    .
            Wall Shelves
.                                                                    .
            Women’s Clothing
.                                                                    .
            Additional Items




            Total




2/26/2010                                                          Page 17 of 27
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                        Home Inventory Checklist

                                        4th Bedroom
    # OF                         ITEM                 Year Purchased          $$

            Bedding
            Beds
.                                                                        .
            Books
.                                                                        .
            Bookshelves
.                                                                        .
            Cabinets & Contents (Attach list)
            CD’s
            Chairs
.                                                                        .
            Chests & Contents (Attach list)
                                                                         .
            Child's Clothing
            Clocks
            Closet Contents (Attach list)
            Computer
.                                                                        .
            Desks
            Drapes
            Dressers & Contents (Attach list)                            .
.                                                                        .
            Dressing Table
            Electronic Games
            Entertainment Center
            Fitness Equipment
            Furniture
            Games/Toys
.                                                                        .
            Lamps
            Men's Clothing
            Mirrors
            Other Storage
            Pictures
                                                                         .
            Radios
            Rugs
.                                                                        .
            Sewing Machine
            Software
            Sporting Equipment

2/26/2010                                                              Page 18 of 27
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                         Home Inventory Checklist
                                       4th Bedroom
    # OF                        ITEM                 Year Purchased          $$

            Stereo
            Tables
            Tables
            Telephone
                                                                        .
            Toiletries
            Trunks & Contents
            TV
.                                                                       .
            Wall Shelves
.                                                                       .
            Women's Clothing
.
            Additional Items




            Total




2/26/2010                                                             Page 19 of 27
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                       Home Inventory Checklist

                                Attic/Basement/Garage
    # OF                       ITEM                     Year Purchased          $$
            Auto Equipment
.                                                                          .
            Bicycles
                                                                           .
            Dehumidifier
            Dryer
                                                                           .
            Garden Furniture
            Garden Tools
.                                                                          .
            Hand Tools/Carpenter’s Tools
.                                                                          .
            Heating Unit
            Lawn Furniture and Games
.                                                                          .
            Luggage
            Mower
            Other Equipment
            Power Tools                                                    .
            Rugs

            Snow Blower
                                                                           .
            Sports Equipment
            Storage
            Tables
            Washing Machine
            Workbench
            Additional Items




.                                                                          .
            Total




2/26/2010                                                                Page 20 of 27
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                        Home Inventory Checklist

                                   Special Valuable Items
    # OF                         ITEM                       Year Purchased          $$
.                                                                              .
            Antiques
            Bracelets
            Brooches
            Cameras
            Central Air Conditioning Unit
            Central Heating Unit

            Earrings
            Fine Art
                                                                               .
            Firearms
                                                                               .
            Furs
.                                                                              .
            Hobby Collection
            Lawn Mower
            Necklaces
            Other Jewelry
            Other Tools
            Power Tools
            Rings
            Silverware/Goldware
            Snow Blower
            Sporting Equipment
            Toys
.                                                                              .
            Watches
            Additional Items




.                                                                              .
            Total
2/26/2010                                                                    Page 21 of 27
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                        Home Inventory Checklist

                                      Girl’s Clothing
    # OF                       ITEM                     Year Purchased     Original Cost
.                                                                          .
            Blouses
            Coats
            Dresses
            Gloves
            Hats
            Jackets
            Jewelry

            Lingerie
            Purses
            Robes
            Scarves
.                                                                          .
            Shoes
            Skirts
            Slacks
                                                                           .
            Sleepwear
.                                                                          .
            Slippers
            Sportswear
                                                                           .
            Stockings
            Suits
            Additional Items




.                                                                          .
            Total




2/26/2010                                                                Page 22 of 27
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                        Home Inventory Checklist

                                  Women’s Clothing
    # OF                       ITEM                  Year Purchased     Original Cost
.                                                                       .
            Blouses
            Coats
            Dresses
            Gloves
            Hats
            Jackets
            Jewelry

            Lingerie
            Purses
            Robes
            Scarves
.                                                                       .
            Shoes
            Skirts
            Slacks
                                                                        .
            Sleepwear
.                                                                       .
            Slippers
            Sportswear
                                                                        .
            Stockings
            Suits
            Additional Items




.                                                                       .
            Total




2/26/2010                                                             Page 23 of 27
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                       Home Inventory Checklist

                                      Boy’s Clothing
    # OF                       ITEM                    Year Purchased     Original Cost

            Bathrobe
            Belts
            Gloves
.                                                                         .
            Hats
                                                                          .
            Jewelry
.                                                                         .
            Pajamas
.                                                                         .
            Raincoat
            Shirts
                                                                          .
            Shoes
            Slacks
            Slippers
            Socks
            Sport Coats
            Sportswear

            Suits
            Sweaters
            Ties
            Underwear
            Additional Items




.                                                                         .
            Total




2/26/2010                                                               Page 24 of 27
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                       Home Inventory Checklist

                                      Men’s Clothing
    # OF                       ITEM                    Year Purchased     Original Cost

            Bathrobe
            Belts
            Gloves
.                                                                         .
            Hats
                                                                          .
            Jewelry
.                                                                         .
            Pajamas
.                                                                         .
            Raincoat
            Shirts
                                                                          .
            Shoes
            Slacks
            Slippers
            Socks
            Sport Coats
            Sportswear

            Suits
            Sweaters
            Ties
            Underwear
            Additional Items




.                                                                         .
            Total




2/26/2010                                                               Page 25 of 27
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                         Home Inventory Checklist

                                   Hobby/Sports Equipment
    # OF                          ITEM                         Year           $$
                                                            Purchased
            Bicycles
            Boats/Rafts
            Bowling Equipment
            Camera Equipment
            Camping Equipment
            Collection -- Coin
            Collection -- Stamp
            Collections -- Other
            Exercise Equipment
            Fishing Equipment
            Games
.                                                                       .
            Golf Clubs
                                                                        .
            Guns
            Ice Skating Equipment
                                                                        .
            Roller Skates/Roller Blades
.                                                                       .
            Ski Equipment
.                                                                       .
            Tennis Equipment
            Additional Items




.                                                                       .
            Total




2/26/2010                                                               Page 26 of 27
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                    Home Inventory Checklist

                               Other
    # OF                ITEM               Year           $$
                                        Purchased




.                                                   .



                                                    .



                                                    .



.                                                   .

.                                                   .




.                                                   .
            Total




2/26/2010                                           Page 27 of 27

				
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