
You can print this form and store for your
records.
| Quantity | Item | Date Purchased | Purchase Cost | Replacement Cost |
| ______ | Carpets/Rugs | ____________ | ____________ | ____________ |
| ______ | Chairs | ____________ | ____________ | ____________ |
| ______ | Clocks | ____________ | ____________ | ____________ |
| ______ | Closed Contents | ____________ | ____________ | ____________ |
| ______ | Cupboard Contents | ____________ | ____________ | ____________ |
| ______ | Curtains/Drapes/Blinds | ____________ | ____________ | ____________ |
| ______ | Lamps | ____________ | ____________ | ____________ |
| ______ | Mirrors | ____________ | ____________ | ____________ |
| ______ | Floor covering | ____________ | ____________ | ____________ |
| ______ | Paintings, etc. | ____________ | ____________ | ____________ |
| ______ | Tables | ____________ | ____________ | ____________ |
| ______ | Shelves | ____________ | ____________ | ____________ |
| ______ | Sundries | ____________ | ____________ | ____________ |
| ______ | Vacuum cleaner | ____________ | ____________ | ____________ |
| TOTAL | ____________ | |||