**INVENTORY OF**

**PERSONAL PROPERTY AND HOUSEHOLD FURNISHINGS**

THIS IS THE PERSONAL INVENTORY OF

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AND

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The attached itemized lists may be used as summary sheets during your
personal inventory, prior to pack-out day. For a complete itemized list
of specific personal and household goods, use additional sheets to list
and describe the items listed under \"Article\" and attach the sheets to
each summary sheet provided.

For example, under \"Women\'s Clothing\":

Coats: 10 1970-1993 \$15.00 - 2,000.00 \$5,000.00

On a separate sheet list your coats, etc., write a short description,
the actual year purchased, price and value. When all of your personal
items in this category have been described, attach all sheets to the
summary sheet.

When the packers arrive, another inventory will be made and a general
description of the contents of each box will be on the packer\'s
inventory. This document is a \"statement\" of what the packer has
packed up for you and the condition of your goods at the time of
packing. Your own inventory is more specific and will help you identify
your belongings. See \"It\'s Your Move\" for more informa­tion on \"Why
You Need an Inventory.\"

# WOMEN'S CLOTHING

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Value

  Coats                                                       

  Dresses                                                     

  Hosiery                                                     

  Lingerie                                                    

  Pants                                                       

  Shirts/Blouses                                              

  Shoes                                                       

  Skirts                                                      

  Sportswear                                                  

  Suits                                                       

  Sweaters                                                    

  Others                                                      

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

## MEN'S CLOTHING

  ----------------------- ----------- ----------- ----------- -------------
                                                              Estimated

  Article                 Quantity    Purchase    Purchase    Replacement

                                      Date        Price       Value

  Accessories                                                 

  Coats                                                       

  Jackets                                                     

  Pants                                                       

  Shirts                                                      

  Shoes                                                       

  Socks                                                       

  Sportswear                                                  

  Suits                                                       

  Sweaters                                                    

  Ties                                                        

  Ties/Handkerchief sets                                      

  Underwear                                                   

  Others                                                      

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ----------------------- ----------- ----------- ----------- -------------

## CHILDREN'S CLOTHING\* Name:

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

  Coats                                                      

  Dresses                                                    

  Jackets                                                    

  Pants                                                      

  Shirts                                                     

  Shoes                                                      

  Socks                                                      

  Sportswear                                                 

  Sweaters                                                   

  T-shirts                                                   

  Underwear                                                  

  Others                                                     

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

\*Do a separate inventory for each child

**BABY CLOTHING AND EQUIPMENT Name:**

  ---------------------- ----------- ----------- ------------ -------------
                                                              Estimated

  Article                Quantity    Purchase    Purchase     Replacement

                                     Date        Price        Value

  Coats                                                       

  Changing Table                                              

  Chest                                                       

  Crib                                                        

  Dresses                                                     

  Hand-carried bed                                            

  High Chair                                                  

  Jackets                                                     

  Pants                                                       

  Playpen                                                     

  Rocker                                                      

  Shirts                                                      

  Shoes                                                       

  Socks                                                       

  Stroller                                                    

  Sweaters                                                    

  T-Shirts                                                    

  Underwear                                                   

  Others                                                      

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ----------- ------------ -------------

**HOUSEHOLD FURNISHINGS---LIVING ROOM**

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Value

  Bookcase                                                    

  Books/Manuscripts                                           

  Carpet/Rugs                                                 

  Chairs                                                      

  Clocks                                                      

  Curtains/Draperies                                          

  Desk                                                        

  Fireplace Equipment                                         

  Lamps                                                       

  Mirrors                                                     

  Musical Equipment(s)                                        

  (include piano)                                             

  Pictures                                                    

  Records/tapes/CDs                                           

  Sofas                                                       

  Stereo Equipment                                            

  Tables                                                      

  Televisions                                                 

  VCRs                                                        

  Miscellaneous                                               
  (bric-a-brac)                                               

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

## HOUSEHOLD FURNISHINGS---DINING ROOM

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Value

  Accessories                                                 

  Buffet/Sideboard                                            

  Carpets/Rugs                                                

  China Cabinet                                               

  China                                                       

  Curtains/Draperies                                          \'

  Glassware                                                   

  Pictures/Mirrors                                            

  Table/Chairs                                                

  Miscellaneous                                               

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                         ,                                    

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

**HOUSEHOLD FURNISHINGS---KITCHEN**

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Value

  Appliances                                                  

  Buffet                                                      

  China Cabinet                                               

  Cleaning Equipment                                          

  Clocks                                                      

  Kitchen Cabinet                                             

  Kitchen Utensils                                            

  Major Appliances                                            

  Table/Chairs                                                

  Telephone(s)                                                

  Vacuum                                                      

  Miscellaneous                                               

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

## HOUSEHOLD FURNISHINGS---BATHROOM

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

  Bath Mats                                                  

  Bath Towels                                                

  Hand Towels                                                

  Guest Towels                                               

  Medicine Cabinet                                           

  Personal Items                                             

  Scales                                                     

  Shelves                                                    

  Shower Curtains                                            

  Tables                                                     

  Wash Towels                                                

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

**HOUSEHOLD FURNISHINGS---DEN/FAMILY ROOM/HOME OFFICE**

  -------------------- ------------- ----------- ----------- ----------- -------------
                                                                         Estimated

  Article                            Quantity    Purchase    Purchase    Replacement

                                                 Date        Price       Value

  Bookcase                                                               

  Chairs                                                                 

  Clocks/Mirrors                                                         

  Computer Equipment                                                     

  Curtains/Draperies                                                     

  Desk                                                                   

  Lamps                                                                  

  Radio                                                                  

  Sofas                                                                  

  Stereo                                                                 

  Tables                                                                 

  Television                                                             

  VCR                                                                    

  Miscellaneous                                                          

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         
  -------------------- ------------- ----------- ----------- ----------- -------------

**HOUSEHOLD FURNISHINGS---MASTER BEDROOM**

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Value

  Bed Frame                                                   

  Box Springs/Mattress                                        

  Bureaus                                                     

  Carpets/Rugs                                                

  Chairs                                                      

  Chests                                                      

  Clocks/Mirrors                                              

  Curtains/Shades                                             

  Desk                                                        

  Dressing Table                                              

  Dresser                                                     

  Linens/Bedding                                              

  Miscellaneous                                               

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

**HOUSEHOLD FURNISHINGS---BEDROOM\***

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

  Bed Frame                                                  

  Box Springs/Mattress                                       

  Bureaus                                                    

  Carpets/Rugs                                               

  Chairs                                                     

  Chests                                                     

  Clocks/Mirrors                                             

  Curtains/Shades                                            

  Desk                                                       

  Dressing Table                                             

  Dresser                                                    

  Linens/Bedding                                             

  Miscellaneous                                              

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

\*Do a separate inventory for each bedroom

## HOUSEHOLD FURNISHINGS---GARAGE/OUTDOOR

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

  Accessories                                                

  Auto/Work Tools                                            

  Barbecue                                                   
  Grill/Equipment                                            

  Bicycles                                                   

  Chairs                                                     

  Garden Tools                                               

  Outdoor Furniture                                          

  Power Equipment                                            

  Sporting Equipment                                         

  Tables                                                     

  Miscellaneous                                              

                                                             

                                                             

                                                             

                                                             

                                                             

                                     ,                       

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

**LINENS**

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

\*Do a separate inventory for each bedroom

## COMPUTER EQUIPMENT/SOFTWARE

  ---------------------- ----------- ----------- ----------- -------------
                                                             Estimated

  Article                Quantity    Purchase    Purchase    Replacement

                                     Date        Price       Value

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             
  ---------------------- ----------- ----------- ----------- -------------

**FINE ARTS---(PAINTINGS, PICTURES, TAPESTRIES)**

  ---------------------- ----------- ------------ ----------- -------------
                                                              Estimated

  Article                Quantity    Purchase     Purchase    Replacement

                                     Date         Price       Valoe

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

  **SILVERWARE**                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------- ----------- ------------ ----------- -------------

**JEWELRY**

+---------------------+----------+-----------+----------+------------+
|                     |          |           |          | Estimated  |
+---------------------+----------+-----------+----------+------------+
| Article             | Quantity | Purchase  | Purchase | R          |
|                     |          |           |          | eplacement |
+---------------------+----------+-----------+----------+------------+
|                     |          | Date      | Price    | Value      |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
| ### FURS            |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
| **ORIENTAL RUGS**   |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+

**CAMERAS AND PHOTOGRAPHIC EQUIPMENT**

+---------------------+----------+-----------+----------+------------+
|                     |          |           |          | Estimated  |
+---------------------+----------+-----------+----------+------------+
| Article             | Quantity | Purchase  | Purchase | R          |
|                     |          |           |          | eplacement |
+---------------------+----------+-----------+----------+------------+
|                     |          | Date      | Price    | Value      |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
| ### BOOKS AND       |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
| **MANUSCRIPTS**     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+
|                     |          |           |          |            |
+---------------------+----------+-----------+----------+------------+

**SUMMARY**

  ------------------------------------------------------- ---------------
  ARTICLE                                                 TOTAL VALUE

  Women\'s Clothing                                       

  Men\'s Clothing                                         

  Children\'s Clothing                                    

  Baby Clothing and Equipment                             

  Living Room                                             

  Dining Room                                             

  Den/Family Room/Home Office                             

  Kitchen                                                 

  Master Bedroom                                          

  Other Bedrooms                                          

  Bathroom                                                

  Linens                                                  

  Garage/Outdoor                                          

  Fine Arts                                               

  Silverware                                              

  Jewelry                                                 

  Furs                                                    

  Oriental Rugs                                           

  Cameras                                                 

  Books and Manuscripts                                   

  Computer Equipment                                      

  Total Value                                             
  ------------------------------------------------------- ---------------

I, the undersigned, do solemnly swear that these assembled pages
constitute a complete list of my personal and household effects now in
my possession at:

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature(s):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Subscribed and sworn to before me this
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ day of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 20\_\_\_.

Signature of Witness
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Note: These inventory pages can be duplicated, completed, folded, and
stapled together to constitute an official listing of your personal
property.