A FARMERS’ MUTUAL FIRE INSURANCE COMPANY. 
Form for policy: 
33 - 
FARMERS’ MUTUAL FIRE INSURANCE COMPANY 
LOCATED AT 
In consideration of the agreement contained in the application and of .._... dollars ($.__... ), duly re- 
ceived. does insurers 25. 222 --5<% Of eee , Subject to the provisions of its by-laws, fora termof.._... 
Name of Hoey hte Addre 
years, from the ...... GayiOfs. sane 7 ite vat noon, to the ...... dayrot 232 - , 192.., at noon, against all 
Girect loss or damage by fire or lightning, except as in said by-laws provided, to the hereinafter-described 
BRODY , located on the ...-... rs of thes. oe - + of section. ..... ORES 32 township, ...... county, State 
r Tnsur- | 
Value. ; |Class 
ance | 
| ee 
Diwellunondescnibediandundicatedinappucatomar ie mscsios- Joss osc neces esas es eo leew eee aes | 
Fo useholdseoodsam diwellim eee eee eee ein ee tints ine Sete easiness aiel| Maeda well ae icoas sate lene 
Wearing apparel in dwelling mS OOS Sb At CESS SE Se GS a ieee es rare oE te | eg ee (ec | eect 
Provisions THUG nO Me i a NS CAS eas a Nett er ce | 
Musical instruments in GiwellingerasHollow Sete serene sores see ee eee eee Al nae eee reef Roses fos owns 
ae eee A ara aye ua er ee tee uae oy Sf Sekai ene oe plat iaia eiceeis CiMelede «clas othe wiecihaes agement 
Summer kitchen, described and indicated in application..........2...........|.....2222-).0222----- Pate | 
Woodhouse, described and indicated in HOVE ALOIS es Nae Se iS icc acueh Sie (eas aca aN te | cael Oe {eens 
Granary, described and indicated in application......-._........2..-....-....|_...--.---|....--...|.-. 0. 
Contentsiohanove-emWoOued eran aKye ingests =o sin e sine ieee oe isles oo se oe eee (acing ne valence ec 
Cornerib, described and maeedeal MoplcanGneee we te Medes ec le i 
Contents Ola boOv.e Meninione diCOLN Chi Dessert see ee ee aoe ae ee Saeee Aen ese arereme | eeieieren | 
Hog house, described and indicated in application..............:........---0.|...-.2.-..|...-- 22s _lose eee 
IGGREITEG SC sas saw Sor ses cA See ae cess as lis sg Ea te eed 1 et Oat Se aR | 
IDDINEE TCT CUS SENG OOS (SSE Sea = Saree oo dadr ar sae c pee aoe son- no ocee eal hea Sekee | eee pena ie acer 
VVOROIMS: CAIDHCOS: PyaGl INR IMIe SSS Gags. Soeec Cae aoe ee ae ee ee ars eerie eens el | a rp nee Ieee 
Horses and mules, OHH CG YS) ra See Oe A ere es ae ee re RS ee eee ences ae el (Ate fared a (oc eee 
CactlerenuEMbe neater pone eee Saas aise Soe <n See elo oeenie S's che meee sie Nee eel ae ee ee ee 
Barnwcdescribed andandicated in application 100200...) 25-2 scn cso es ecg e es ee slceec tee look 
Hay and CHAMPA HO VEe=IMEM EI OMe CED ALM rere eiS ech tee ilo Serie airs ell ae ae Screl| ru seas es Alle sees iae tell eave 
Silo with contents, described and indicated in application....:.5..2.2- 2222-22 2\-22.5.2..-|b22.- 22 eee ee eee 
SUMMARY. 
| | 
Tnsur- F | Initial 
Class | 
ANCOR Yana |  pre- 
class, | 22¢ ee | mium 
Parte es pei oNN ten een 
ee ae € ROA a eee em eat 
a tot te | D BOOS Moe eee 
rea eee a 1D; 4 (i; | Seaeceeee 
So | ef eset ee fe Wotalse|eaes ste 
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 $ ...... , Nor in any case 
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 Gay of 1O1es. 
eeeeee UGY UL Lc. ee ey 
BCC OCD DOOODME COS CESS SOO ECO ODOR ECO OOS O DOD 
Secretary. 
