Missing Items Statement Sample

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					                     MISSING ITEMS STATEMENT SAMPLE
On June 18, 2005, ABC Relocation delivered my household goods to my address in Arlington,
Virginia. The following items were missing upon delivery:

               24 foot aluminum extension ladder
               Panasonic canister vacuum cleaner
               JVC 21 inch television
               Ryobi electric drill

The ladder was kept in the garage at my old home. I used it to clean the gutters and for other
outside chores. I specifically checked the garage before the movers left because, due to the
number of movers, my wife and I were not able to watch the packer pack up our garage items.

I used the vacuum cleaner part of the time the movers were there, then unplugged it and left it in
the master bedroom where the movers were still packing things. The TV was in my home office.
I last used it the morning of the move as I packed up papers to hand carry.

My Ryobi drill was in the office. I had used it for some repairs and never returned it downstairs
to the basement with my other tools.

My wife and I checked the entire house before I signed the inventory, including all rooms and
closets. The TV and vacuum, along with everything else, were packed up and gone.

When our household goods were delivered, the movers, my wife and I all checked for the
missing items but could not find them.

I can therefore attest that these items were made available to the movers for packing

                                             John Soldier
                                             August 26, 2005

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