Replacement Value

Room Total

Living Room

Carpets/Rugs

$ _________________

Sofas, Chairs

$ _________________

Tables

$ _________________

Lamps

$ _________________

Pictures/Mirrors

$ _________________

Window Coverings

$ _________________

TVs, Stereos

$ _________________

Computer

$ _________________

Other (list)

$ _________________

Total Living Room

$ _________________

Kitchen

Appliances

$ _________________

Small Appliances

$ _________________

Table, Chairs

$ _________________

Cookware

$ _________________

Dishes, Utensils

$ _________________

Other (list)

$ _________________

Total Kitchen

$ _________________

Dining Room

Carpet/Rugs

$ _________________

Table, Chairs

$ _________________

Buffet, Sideboard

$ _________________

China, Glassware

$ _________________

Silver

$ _________________

Pictures/Mirrors

$ _________________

Other (list)

$ _________________

Total Dining Room

$ _________________

Bedrooms

Carpet/Rugs

$ _________________

Beds

$ _________________

Bedding

$ _________________

Bureaus, Dressers

$ _________________

Pictures/Mirrors

$ _________________

Desk, Chairs, Tables

$ _________________

TVs, Stereos

$ _________________

Computer

$ _________________

Other (list)

$ _________________

Total Bedrooms

$ _________________

Family Room/Den

Sofas, Chairs

$ _________________

Tables, Chairs

$ _________________

Pictures/Mirrors

$ _________________

TVs, Stereos

$ _________________

Computer

$ _________________

Other (list)

$ _________________

Total Family Room/Den

$ _________________

Garage/Car Port/Shed

Tools

$ _________________

Lawn Mower

$ _________________

Grill

$ _________________

Lawn Furniture

$ _________________

Hobby/Sport Equipment

$ _________________

Other (list)

$ _________________

Total Garage/Car Port/Shed

$ _________________

TOTAL HOUSEHOLD

$ _________________