A FARMERS MUTUAL FIRE INSURANCE COMPANY. 33 



Form for policy: 



FARMERS' MUTUAL FIRE INSURANCE COMPANY 



Located at 



In consideration of the agreement contained in the application and of dollars (? ), duly re- 

 ceived, does insure of , subject to the provisions of its by-laws, for a term of 



Name of insured. Address. 



years, from the day of , 191. ., at noon, to the day of , 192. ., at noon, against ail 



direct loss or damage by fire or lightning, except as in said by-laws provided, to the hereinafter-described 



property, located on the I of the £ of section of township, county, State 



of 





Value. 



Insur- 

 ance. 



Class. 



















































































Contents of above-mentioned granary 











































1 







1 















































































































SUMMARY. 



Insur- 

 ance by 

 class. 



Class 

 and rate. 



Initial 



pre- 

 mium. 





A .15 

 B .20 

 C .25 

 D . 33 

 E . 40 

























Totals.. 











And said company promises and agrees to indemnify the insured against loss or damage from the above 



mentioned causes, in the amounts above specified, not exceeding a total sum of S , nor in any ease 



exceeding the cash value of the property immediately before the loss or damage occurred. 



In witness whereof the Farmers' Mutual Fire Insurance Company has executed and attested this 



policy on this day of , 191... 



President. 

 Secretary. 



