INVENTORY OF HOUSEHOLD GOODS

PROPERTY OF FROM

INVENTORY OF HOUSEHOLD GOODS

HOME PHONE NUMBER

DUTY PHONE NUMBER

TO (Destination)

DATE

ARTICLE

LIVING ROOM Bench, fireside or piano Bookcase Bookshelves, sectional Cabinet Cartons, books Chair, arm Chair, occasional Chair, overstuffed Chair, rocker Chair, straight Clock, grandfather/grandmother Credenza Davenport, 2, 3, 4 cushions Day bed Desk, small or Winthrop Desk, secretary Footstool, hassock, ottoman Hideabed Lamp, floor, table Magazine rack Organ, electric Piano, baby grand or upright Parlor grand Spinet Radio, table or phonograph Sectional, 2, 3, 4 piece Stereo, Hi Fi Studio couch Tables, drop leaf or occasional Tables, coffee, end or nest Table, library Telephone stand and chair Television combination/color Television, table model/color 0 DINING ROOM Barrel, dishes Buffet Chair, arm Chair, straight China closet Server Table, dinette Table, extension 0 0 0 BEDROOM Bed, include. spring and mattress Double Single or Hollywood Bunk (set of 2) King size/Queen size Cartons, clothes Chair, boudoir Chair, straight or rocker Chaise lounge Chest, cedar Dresser, bureau, chest of drawers, chifrb. or chifnr. Dresser bench Dresser, double, triple Lamps, floor, table Table, night Wardrobe, small Wardrobe, large Wardrobe, carton 0 CHILDRENS ROOM Bathinette Bed, youth cartons, clothes Chair, child's Chair, high Chair, rocker Subtotal Column 1

CU FT. PER PC.

NO OF PCS

CU FT.

ARTICLE

0

0

5

20

5

10

2

10

15

25

12

5

20

35

35

30

22

35

0

50

3

2

60

70

80

60

2

50

10

50

12

5

20

5

25

10

0

0

15

30

8

5

25

15

15

30

0

0

0

0

0

60

40

70

70

10

10

5

25

15

0

25

3

50

3

5

20

40

10

0

0

5

30

10

3

5

3

1460

0

CHILDRENS ROOM (Con't)

Chest

Chest, Toy

Crib, baby

Play pen

Table, child's

0

KITCHEN

Boxes, pots/pans

Cabinet, kitchen

Cabinet, utility

Chairs, breakfast

Ironing board

Rotisserie

Stool

Table

Table, breakfast

Vegetable bin

0

0

0

APPLIANCES (Large)

Air conditioner, window

Dehumidifier

Dishwasher

Dryer, electric or gas

Freezer: (Cubic capacity)

10 or less

11 to 15

16 and over

Mangle

Range, electric

Refrigerator (cubic cap.)

6 cu. ft. or less

7 to 10 cu. ft.

11 cu. ft. and over

0

Vacuum cleaner

Washing machine

Washer/dryer combination

0

0

0

PORCH, OUTDOOR

FURNITURE & EQUIPMENT

bar

Bar stools

Bird bath

Chair, porch

Chair, lawn

0

Fireplace equipment

Garden hose

Glider

Grill, barbecue, portable

Gym, outdoor child's

Ladder, extension

Lawn mower (hand)

Mower, power

Picnic table

Picnic bench

Rack, outdoor dryer

0

Rocker, swing

Sandbox

Settee

Slide, outdoors, child's

Swings, outdoor porch

Table

TV antenna

Tool chest

Umbrella

Wheelbarrow

0

0

0

PROFESSIONAL ITEMS

Clothing, specialized

Instruments

MARS equipment

Subtotal Column 2

CU FT. PER PC.

NO OF PCS

CU FT.

ARTICLE

0

0

0

PROFESSIONAL ITEMS (Con't)

12

Reference material

5

Tools

10

Books

10

Papers

5

Equipment

0

0

5

30

MISCELLANEOUS

10

Ash or trash can

5

Auto tires

2

Basket, clothes

5

Bicycle

3

Bird cage and stand

5

Brooms and mops bundle

10

Cabinet, filing

3

Carriage, baby

0

Carriage, doll or folding

0

Chairs, folding

0

Clothes hamper

0

Cot, folding

30

Golf bag

10

Golf cart/go cart

20

Fan

25

Fernery or plant stand

0

Foot locker

30

Heater, gar or electric

45

Incinerator

60

Linens, cartons

12

Mirrors

30

Pictures

0

Power tools

30

Rollaway bed

45

Rugs, large roll or pad

60

Rugs, small roll or pad

0

Sewing cabinet

0

Sewing machine

0

Shop smith

Sled

Table, card

0

Tricycle

0

Trunk, steamer

15

Trunk, wardrobe

3

TV trays

5

Typewriter

10

0

5

OTHER ITEMS

5

5

20

10

20

10

5

15

20

5

5

15

10

CONTAINERS PREPACKED

20

BY OWNER, e.g.,

10

Footlockers or Trunks

30

10

5

10

5

3

0

Subtotal Column 3

0

0

TOTAL Column 1

0

TOTAL Column 2

0

TOTAL Column 3

0

0

GRAND TOTAL

793

Summary 0 cu. ft. @ 7 lbs. per cu. ft.

Estimated Total Weight

CU FT. PER PC.

NO OF PCS

CU. FT.

0

0

0

0

0

0

0

0

0 0 0 7 2 5 5 5 2 20 20 5 2 5 3 2 3 5 0 0 5 10 5 0 0 0 20 0 0 2 10 0 2 1 5 10 15 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 180

1460 793 180

2433 0 lbs. 0 lbs.

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APPLIANCES TO BE SERVICED

TYPE (Place "X" in applicable boxes) CLOTHES DRYER

MAKE

GAS

ELECTRIC

WASHING MACHINE

AUTOMATIC IRONER

NON AUTOMATIC

YEAR

MANGLE FREEZER

CHEST REFRIGERATOR GAS

SINGLE DOOR TELEVISION TABLE

CONSOLE STOVE

UPRIGHT

ELECTRIC DOUBLE DOOR PORTABLE

GAS DISHWASHER

ELECTRIC

AIR CONDITIONER

STEREO

HI-FI RADIO

RECORD PLAYER

OTHER (Specify)

THE FOLLOWING ITEMS ARE TO BE WITHDRAWN AND PLACED IN NON-TEMPORARY STORAGE IN THE EVENT WEIGHT IS IN EXCESS OF THE ADMINISTRATIVE WEIGHT RESTRICTION:

1.

2.

3.

4.

5.

6.

Name

Grade

Service Number/SSAN

NOTE: Disconnecting or connecting of appliances to gas, water or electricity will not be performed by the carrier. Arrangements for disconnecting or connecting must be made by the owner. Carriers will not remove or install TV antennas or air conditioners.

INTERVIEWER'S NOTES

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