Missouri

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SCHEDULED PERSONAL PROPERTY SUPPLEMENT

NAME _____________________________						POLICY # ___________________

This form is to be submitted only when additional space is required to schedule personal property. Subtotal by Class. Circle all classes that apply:
1.	JEWELRY	5.	SILVERWARE	8.	STAMPS
2.	FURS	6.	GOLF EQUIPMENT	9.	COINS
3.	CAMERAS	7.a.	FINE ARTS (WITHOUT BREAKAGE	10..	FIREARMS
4..	MUSICAL INSTRUMENTS	7.b.	FINE ARTS (WITH BREAKAGE)

# & CLASS	DESCRIPTION	BRK	$ LIMIT
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5261 (07/2005)