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)	11.		COLLECTIBLES

# & CLASS	DESCRIPTION	BRK	$ LIMIT
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5261 (03/2006)