| JEWELRY | No. | Original Cost |
Present Value |
| Watches | |||
| Rings | |||
| Necklaces, chokers | |||
| Pendants | |||
| Bracelets | |||
| Earrings | |||
| Pins, brooches | |||
| TOTALS | |||
| FURS | No. | Original Cost |
Present Value |
| Coats | |||
| Capes | |||
| Jackets | |||
| Stoles | |||
| Scarves | |||
| TOTALS | |||
| FINE ART | No. | Original Cost |
Present Value |
| Paintings | |||
| Etchings | |||
| Statuary | |||
| Figurines | |||
| Other art | |||
| TOTALS |
Fulmont Mutual Insurance
Company
Main Office: P.O. Box 487, Johnstown, NY 12095-0487
Page: __________ of __________