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Home My WebLink AboutFarmers Mutual Ind Association of Cayuga County but Groton ResidentsTHE FARMERS9 MUTUAL INDEMNITY ASSOCIATION of Cayuga County A LIC TION OF ..... R. D...... .............. Countyof..... ................................. ..... State of .......... Town of ............ Pretnium............ .... - ............�...�7 ..1.. Cam, Discount for approved Lightning Rods...., .............. $......�..... . Total..................................�� .... . Date of Risk .............. .... �...��..�....192 Time ...................... years. SOLICITOR. Renewal of Policy .... .......... . ' Reinsured No....... .. ...... Material of house No. 2............................. Age ............ years. In what repair ?................................ Is it necessary and c c remunerative in its resent condition ?......... r P ...... Is it painted ................ Is it plastered ?............... Are the stove., aU a pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept ?........................ v .......SOLICITOR, EAST NO 4, W G z o r/� G C O a z C. 440 H P a" a vm a ao a M o 0 0 �, a c''Aa b WEST •� I-Applicatioll of .......... R. F. 1 1'()Stol ---list 1(),,s ()r damage by tire (w lighirlin(r ill of _New York, t, r" . r, County for insurance agal THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for t,li(- term of.... ........years front P - 71'.. (lax, id f ...... I ......... 1924 Z, the F()Nvll cif at, nooi), on property located ( )TI •..X...sidt- ad ..... miles fr(on.b...Wj. r L .......... G,untv (d..v ... . . .. 1 ...... and State of New York, a, fo)lI- A mou tit, 11'sured Insured .... On Dwelling House and Attachments ........ ........ Oil Household Furniture, Printed Bookq,, Pictures, Silver and Plate, Provisions and Wearing Apparel im premises 0 $* . ..... ..... Oil Piano '5 . .................On Organ ................ On Phonograph and Record.9 ..................Oil.... ................................... ...On 11.11,11 No. I -dalN J ..v.. On Barn No. 21 $ .................. On Burn TNo. 3 �1 ........ ......... (--)n Barn No. 4 ........ ... On Hog House ...... ...On -I'll House -Al ......... 7.J.. On (.,4)rn IW-n $ ......... ...... . On Produce tm 1'reynises $ ................. On Farming Utensils, Carriages, In M_ n Robes, Harness and Automobiles ..... ............ On Horses ..................On (latt I" $ . ............. Oil Register�,d Cattl,� ..................On Sheep ..................On Fowls ................. on swil e . ............... ... I .. ...... ...................... ..... ........ ............ .."ITotall ............Rate ........... Premium How niany acres of land in this place?............ What is the vailie of the land and buildings? $ ... ........ 11()w 'nAnY stories in dwelling house?...... By when occupied?......... .......... .............. Is it painted outside? .(f. ......... Inside ..... Is the first story plastered ..... Second storv?..--//., Are the chityineys all of brick?."./ Are they in good condition ........ 11(yw high above the r,()()f is the lowest?...... .......... feet. The plpeA "Ve in good condition, safely secured and, enter the chiumey horizoritall), by a thirnble or are firmly ceniented therein. All wo,)d a,s hes are kept at leant thirty feet from any insnredl building- or in .................................... ........... ........... Value Material How Old? Cover Roof Condition Painted SIZE OF BUILI)INHv;ght I 6',", of Posts, u!ie ........ $ ............... .......... ...... .......... .................................. I ........ x ......... a ......... x ...... I ........... ....... ..... Bar i i No. L. $ ................ .................. ........... .... ................. ........ I .......... ......... x ......... a .... Rparn No. 2..$ .............. .................. .................. .................. .................. .......... ........R. .............. BartiNo. :3..$ ................ ................. .................. .................. ................ I . ..... I ............... ......... ....... **---* .. ................. ......... ........ .................. ..................... ......... x ....... a.... .• Loss, if any on buildings, payable .............. x...... ..... ........ x..... ............. .X .............. ................................. Mortgagee..... , as................ Interest...... may appear. What bnildit,gs, if any, are equipped with lightning ....... ............ Name of manufacturer? .............................................................. Date installed ? .......................... Are all ground connections satisfactory ? ............ Total rosin once on roddpd buildings 25 per cent -discount, for rodded building; Has the Applicant ever had a fire? ............... If so, gives origin ,ind, explanation ...... ...................................... Has the Appliefint anY special reason I,"() fear fire from incendiarism ? ............... Is there any other Insurance on this property, or any other exposed with it, in this Company ? ............ If so, state amount $ .............. Name of Insured ........................................ No. of P,)Iiex . ................ Is there any other Insurance in any other Company ? ......... If so, state amount and what it covers, on back. What is your title or interest in the property ? ......................................... How MLICh is it encumbered? ........................... I .............. I . ..... In Consideratiort of the Insurance obtained on property Danied, I do hereby give my Undertakin's, whork-by I bind nivself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by ajjv member thereof, during illy membership. Given in pursuance of Section 7 of the Act under- which the Association organized and in conformity with the By -Laws of the Association. The Solicitor will please answer the following QlIeStiODS Have you carefully examined the above risk? .............. When did you inspect the risk inside and outside? . ...... .. ..... Did you then inspect the chinmeys and pipes where they pass through partitions and floors and enter chimileys?.................. Are they apparently safe?. ....... Do you know of any facts creating moral hazard ? ......... 4-4.4 Z_ . . ...... 'olleftor. E � 3 ....... ........ .. Material of house No. 2 ?......... ... .�. .Age........... years. In what repair ? ..... Is it necessay and ° MUTUAL... Are the stoves i esFARMERremunerative in its present condition ?....... ...... Is it painted ?.................. Is it plastered? , pipes U and chimneys in good condition and apparently safe ?........................ Where and how are ashes kept ?...................................... .c IATION INDEMN ITY ASSO C .� .......................................................................................SOLICITOR. 0 CayugaCountylof East i APPLICATION OF • t .� ..N"l. .......... R. D............... t .° ° : County of.!"e,....... State of. ...... ........� ......................... o c o y Town of...... . .............. �. C� �% W fA cad -- --------------------- H � O o Premium.............................�..ls.� ..... '� z ce C3 Survey Fee ................................ A �b Total...................................$.1. Cti ... a b A -------- -- — - --- --- - F, :a Date of Risk...-:�L:.,.....191 a y Time......................years. i • ~ SOLICITOR. o Renewal of Policy No ............................ Reinsured No......�:..�:.,.. .....:,�;............. .� •1N�111�N��rN��'rN1N�� a c Isom Eppltcation of+�� : ..... .... � ...&... /11:::�......... R. F. D. No . 2 Phi • ........ Postoffice ................�...Z............. County of. :�.�y.,. � ;� '/:� ...........and State of New Fork, for insurance sgain-st lass cr damage by fire or lightning in the /` " g g g FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V., for the term of......��'........years from the t l .day of. ..+!� .� ..........191.,� at noon to the/./..day of..... ......I� .' < ✓:.. at noon, on property located in the town of-:�! ..`.� ... ......... - Cayuga , as follows ••••••-••.•••••-•..•County of and State of NewZor Amountk Value of j Height Insured Buildings' of Posts SIZE OF BUILDINGS ..3. On Dwelling House and Attachments....... 5,q ............................. ............ x............ a ............ x............ i On Household Furniture, Provisions and Nearing Apparel, therein and oil premises ....................... .............. - -.... ...... i On Piano, $........ Organ, $......... Dlelodeon, $......... therein ................ On Printed Books, Pictures, Silver and Plate therein....... • • . • . • • .. • • • • On.................................. ......... ..................................... .......... :;,:................. ............... OnBarn No. l ............................ .. ...... .... .... f.. ................. .. .... . OnBarn No. 2............... ....... ............................................................... .......x........... a............x............ OnBarn No. 3...... ....... ............... ................. ............ ............... ..... . ...... I OnBarn No. 4.......................................................... ....... ............... ............... ..... .....................x............ a ............ x.... OnCorn Barn or Granary............................................................................................. .. ..... ...... On Produce in said Barns and on Premises........................0........... PRESENT NO. OF ANIMALS On............................................................................................................................ Horses............... Cattle............... Oil Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep ............... Fowls............... in said buildings and on Premises ......................................... INDIVIDUAL LIMIT ON Orr Live Stock, On Horses, $ '...... Orr Cattle. ................... ..... Horses $............... Cattle $............... to -wit . On Sheep, $......... On Fowls, $....................... ISheep $............... Fowls $............... Rate..,..* ........................... .................. Total, I Premium....... . situated in the town of..........................Cayuga County, N. Y. How many acres of land in this place ?............ What is the value of the land and buildings ? $..................... Of what material is the house ? How old is it? ............ vears How many stories ?............ For what is it occupied ?..................... By whom ?....................... Is it painted outside ?............ Inside ?............ In what repair ?............... Is the first Second .econ story plastered ? .............. story .............. Are the chimnevs . � all of brick ?.......... Are they in good condition ?........ How high above the roof is the lowest ? ........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in ................................................... Barns —Material. I How Old? Cover of 'Roof. Condition. How Finished ? i Painted. No. I ................. ......................... .................................................... .................................................. ! ........................ . No. 2........... .......................................................... .... . ... ............ ...... 3--------------- --................ ---------- --------------------------- ---------------------- Loss, if any, on buildings, payable to.................................................................................................... ...................................... .................................................... .......... as .................................... Interest ............ may appear. Has the Applicant ever had a fire ?........... If eo, give origin and explanation............ ....................... Has the Applicant any special reason to fear fire from incendiarisrn ?..... ...... Is there any other Insurance on this property, or any other exposed with it, in this Company- ?............ If so, state amount $............ Name of Insured ................. ..........................No. of Polio................ Is there any Insurance in any other Company ?............ If so, state amount and what it covers, on back. What is yorrr title or i nterest in the property ? .................................................. How much is it encumbered ? $......................................... In Consideration of the Insurance obtained on property narr►ed, I du hereby give rr►y Undertaking, whereby I bind myself and my heirs, execrltors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cavuga Connty, N. Y., inv pro rata share. of all liabilities incurred by the Issociation, and all losses by Fire or 4ightning, sustained by any member the►•eof, during rr►y membership. Given in pursuance of Section 7 of the Act tinder which the Association it, organ- ized and in conformity with the By -Laws of the Association. ........................... _....... ....... ............. ..... ............... Applicant. The Solicitor will please answer the following Questions: — Have you carefully examined the above risk ?............ When did you last examine it ? ..............................Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys ? ..................Are they apparently safe ? Do you know f anv acts creating moral hazard ? ......Pate of Ins �ection�/. .......�.�. ..........191. ....................�. ...:�i::...:.... a :....`.....� ...;. I, .... ••r• ..,. .Solicitor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of a Ca UCountyyg ----I lRo.-------�- �_ -- -�, -- LI T N OF ......... . D.......... 0 0 County of...... .. ..................... 0 Stateof ............ ............... .................. � Towno#... . ................ Z. �.� :..... Premium ................................... v.. Discount for approved Lightning Rods ..................... $....... ........ d Total............ ........... $ ... Date of R i ... .....192... Time......... ............ ^ ..:.years. ....... ......... SOLICITOR. 0 Renewal of Policy No.'.. .. Reinsured No ............::.... j&jbe%,0%,� Material of house No. 2...... ......................... Age ...........years. In what repair................................ Is it necessary and remunerative in its present condition ?.................. Is it painted ? ................. Is it plastered? ................ Are the stoves, pipes and chimneys in good condition and apparently safe? .................... Where and how are ashes kept?.........: ..... i L ......................................................................... SOLICITOR. EAST WEST cc zipplICati ..... .. .. ...... �....... RI. F. I)., No............ Posto e................................. ........ Connh� of....... ..............and State of N ork, for insurance against loss or damage by fire or lightning in THE ARMERS' MUTUAL INDEM V ASSOCIATION, of Cayuga County, N. for the term ..........years front the..... .... day .................. . ...192-. �,o e. at noon, t.�..day ....• . ...... 2 :.......................... .. in the Town of at n rn, on property located on tl ..............sid of...................ro�td, .........inilf_s from. •• • •••• . .... ..... ........County o ... .. id State of New York, as follows: A mount Insured Z..'� ...........On Dwelling House and Attachments ................On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises $............... .On Piano .................On Organ $ ..................On Phonograph and Records ...../ ........On .... ............. ..................................... barn No. i $.................Ori Barti No. 2 ..................On Barn No. 3 $ ................On Barn No. 4 $... ...............On Hog house $ .................Ori Hen limise Amount Insured .................On Corti Barn or Granary $.� .?� .On Produce on Premises CTn Farming Utensils, Carriages, Sleighs, • .. Robes, Harness and Automobiles $.... ... ........On Horses ..................On Cattle .............On Registered Cattle .......On Sheep ...............On Fowls .........On Swim ...............On. ' ....................:.... ....... ...... .......... 4f ..... ...On ........... .........:. ` :.... -otal ...Rate ..... Premium How many acres of land in this place? ........... What is the value of the land and buildings? $........... How many stories in dwelling house?.......... By whom occupied? ............ ... .. Is it painted outside? .... Inside ?... Is the first story plastered � Second story? ............... Are the chimneys all of brick ..�.. Are they in goo condition? ..................... How high above the roof is the lowest? .................. feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in............ ... .............................. Value Material How Old?Cover Roof Condition Painted SIZE OF BUILDINGS Height of Posts House........ $............... ..... ............................................................. .............................. x.........a.........x...... BarnNo. L. $................................................ ................ ................ .............�..a......... x ..... _....:..." BarnNo. 2.. $........................................................................................................... .........x ........ a ......... x...... ............. BarnNo. 3..$. ............................... ................. ...................................I .............................. x. a.........x. ....... ..... ............. ..................$............................... .......................... ........ ......... ........ .................... .........x ........a..... .x...... ...... Loss, if any on buildings, payable to............................................................................................................................... ............ Mortgag•ee..... , as ............... Interest .....nay appear. What buildings, if aii% are equipped with lightning rods?.....��`:�:.::a . ..... . ;�....... ...... Name of manufac turer? actrtrer `? .............................................................. Date installed ? .......................... Are all ground connections satisfactory ?............ Total insurance on rodded buildings.�.��.....: ; 25 percent discount for rodded buildings....tr...Has the Applicant ever had a fire ?............... If so, give origin and explanation............................................. Has the Applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or any other exposed with it, in this Company ?............ If so, state amount $.............. Name of Insured .......................................... No. of Policy................. Is there any other Insurance in any other Company?......... If so, state amount and what it covers, on back. What is your title or interest in the property ? ......................................... How much is it encumbered ?.......................... .................... In Consideration• of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ♦ Y . .�'.........................`............ Ap fricant. The Solicitor will please answer the Following Questions Have you carefully examined the above risk?. .�i .. When did you inspect the risk inside and outside? ......... .. Did you then inspect the ehinyineys and pi they pass through partitions and floors and enter chimneys? .................. Are they apparently safe ?.................. Do you know of any facts creating i :......: 'rL............ ....�. ..`1Solicitor... /p, t, Zt-.Jg , THE FARMERS' INDEMNITY A of Cayuga County ___________ ATIO or .... ...... ............. .... R Countyof......... .... ......................... State of... Townof ......... ........ a�U....... ..... . .. ....... Premium.......... ............... $..... ............ Discount for approved Lightning Rods .................... $........ ......... 9 Total................................... $. ............ Date of Risk.......... ..... ... . .... 19 �.� 3 Time......:.... ...........years. SOLICITOR. Renewal of Policy No.*....' ... '- ReinsuredNo., .......................................... Material of hourie No. I ................................. Age ............ years. In what repair?............................... Is it necessary and remunerative in its present condition? .................. Is it painted? ..... ............ Is it plastered? ..... Are the stoves, pipes and chimneys in good condition and apparently safe? ....................... Where and how are ashes kept? ...................................................... ................. SOLICITOR EAST .° a o 0 U P" z : a ° ° p a� m o z o H o V � �r b � � b `, WEST ,� °' �,:...... R. F. D. No............ Postof%ce............................... Bpplicaq Og........ ............. l ...................... _ ...... County of..::. .�..: ...�::..:..:. z:.:..... and State of New York, for insurance against loss or damage by fire or lightning in THE ARMERS' MUTUAL�NDEMNIT A S CIATION, of Cayuga County, N. for the terns of. ....years from the .....day c,f.' •• ............. (• 192.1. at noon, to the = `... ..day o ............�..192� '` ` ...side o .........road, /Z...miles from.. at (noon, on property located on thee• ••••= •..•. �` :c: `:•: J'ln the town of ..� :.."�..........................LCounty of.,%... ...:, ......and State of New York, as follows :— Amount Amount Insured Insured ......On Dwelling House and Attachments $.................. On Corn Barn or Granary $ ..................On Household Furniture, Printed Books, $..<..::�.��On Produce on Premises Pictures, Silver and Plate, Provisions $...... ,,,,,,,,,,,On Farthing Utensils, Carriages, Sleighs, and Wearing Apparel on premises. Robes, Harness and Automobiles on $ .................On Piano ; $............... Organ ; $.............. premises Dlelodeon. $.................. On Horses $..................On......................................................... $.................. On Cattle $.................On....................................................... $.................. On Registered Cattle $ ..................On Barn No. 1 $ ..................On Sheep $ ..................On Barn No. 2 $ ..................On Fowls $ .................On Barn No. 3 $ ..................On..( ... �:.`.....� ... ................ $ ..................On Barn No. 4 -- $ ..................On Hog House $..................On......�..:............. ......................... $ ..................On Hen House $.................. Total ............Rate ................Premium How man acres of land in this y place ?............ `'hat is the value of the land and buildings? $.................. How marry stories in dwelling house ?............ By whom occupied? ...................................................... Is it painted outside ?............ Inside,.? ......... In what repair? .............. Is the first story plastered ?............... Second story ?.................. Are the chimneys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .............................................................. Material Value How Old ? Corer Hoof Condition How Finished ! Painted SIZE OF BUILDINGS Height of Posts House.........$............................................... ................. ............. ................. .........x ........a.........x........ ............ BarnNo. L.,$................. ............ ................ ................ ...................................... ....... x........ a........ x........ ............ BarnNo. 2..$ ............................... ................ I................. ...................................... .........x......... a........ x........ ........... BarnNo. 3.. $ ............................. ............... ................. ......................................x.........a.........x........ ............ .................. $................-.............. ................ (.................. ....................... .................. ........ x......... a ......... x........ ............ Loss, if any on buildings, payable to -------------------------------------------------------------------------------- --------------------11ortgagee____, as -------------- Interest ---- may appear. What buildings, if any, are equipped with lightning rods? ........ ............................ ............•••••• ......••• Name of manufacturer? Date installed? ........................ Are all ground connections satisfactory ?............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $........ ..... Has the Applicant ever had a fire? ............... If so, giva origin and explanation ............................................. Has the Applicant any special reason to fear fire from incendiarism? .............. Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Insured ....................................... No. of Policy................ Is there any Insurance in any other Company ?....ram.: '�If so, state amount and what it covers, on back. What is your title or interest in the property? ................................................. How much is it encumbered? $............................................ In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rasa share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the. Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ..................................................................... Applicant. The Solicitor will please answer the following Questions :— Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?.......................... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently safe ?.................. Do you know of any acts creatin oral hazai ........OK ...`.... ................ Aolicitor. •wvooww 1lwww® EARNERS MUTUAL 3 � INDEMNITY ASSOCIATION 3 of Cayuga County aceeoeeeeeomeooeeeeooeeeeeoeom000eeeoeooeeceocoeer•.eoea f � acaeraaooroccoe000aaeoeoem000ecw�ooe�aeeoeeceeeaaaec�e+eamoe APPLICATION OF .... ............. ........ ........ A. D....... COLint37 Of .......... State of ..........[tiv ........... . S Town of ................................ N eeeeaeoeecc000eececmoeecoceeeoeoeeooeeceoenceocooeneeoo ceeceeaeaecoeaeeeeceoaeocccoeoecoer�ecen�ou�oanuceecooeo Premium ........ ..........$. 3 Survey Fee ....................... Total ..................... .,.1.�`. ... . cbcr�ooeor_eeoarreeC"C" • roeeeeeooerecceeee0000ceocmoee Date Risk.. .. �' • .. • ..190 Time ..(�......... years. ror•.aaoaa�ceceeoenoor•.eooe�oraaa000eeocmoeoeceM.,MGM eceeoc SOLICITOR. � ceccooeeneoeeeee�oecoeoonoeoeoeoc00000eeoer•.ccencooeeeeeo Renewal of Policy No. ,�.,� �i. 0 ......... Reinsured No ............................. 3 •�eo�ww�rww��wNw��www• Material of House No. 2? .............................. Age .......... years. In what repair?........................ Is it necessary and remunerative in its present condition?....................Is it painted? ................ Is it plastered? ................ Are the stoves, pipes and chimneys in good condition and apparently safe?. ................. Where and how are ashes kept?......... ............. .. ........ ......................... .................. ................... SOLICITOR, East o o C 0 W F H 0-4 H x a Q 14 U : O O O 14 €j iVry�� pplfcatfonof. .. .. . dA.... ... ... ............................................................... R. F. D. No ...... P. 0.1 ..... , , • .................. County of ... , ..................... State of New York, for insurance against loss or damage by Fire or Lightning in the Farmers' Mutual Inde 'ty Association, of CAYUGA COUNTY, N. LLV., in the sum of .7 • • • • • • • • • •e.=" 9.. - • •L.'L....... .. ............DOLLARS, for the term of... ..... years, to wit: Amount Value of Height SIZE OF BUILDINGS. Insured buildings of posts ON Dwelling house and Attachments .i�k.<44- -444-C/ x 1 G a �i x�Z ON Household Furniture, Provisions and Wearing Apparel therein and on premises. G.� •,�,�. G'�` ...... ../ .��.� . ON Piano, S....... Organ, $ ....... Melodian, ........ therein ON Printed Books, Pictures, Silver and Plate therein.... ...... ON................. ........_............................ ON Barn No. I .. leo ��G� . lr'ft,... ��. �� .......�.. ........ .. .... . �& ..Y .0 J!il�rt�. • ,r,�j% ........ x ........ a .... • .. x ....... . ON Barn No. 2............... t��?'L...� •...... ... ...... ........... .......x........ a........x........ ONBarn No. 3.......................................... .......... .......... ......... x........ a .......x........ ON Barn No. 4 .................. ON Corn Barn or Granary, ................................ ON Produce in said Barns and on Premises ............. . ..... . PRESENT NO. OF ANIMALS. ON.............. ................................... .... Horses,........... C:attle,............ ON Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep. ............ Fowls, ............ . in said buildings and on premises..... , , , . ... INDIVIDUAI. LIMIT ON ON Live Stock ON Horses, $........ Caine, S.......... Horses, S......... Cattle, S.......... therein to wit: , ON Sheep, $.......... Fowls, $.......... Sheep, $........... Fowls, 5......... . Rate..... ... �S, ........... Total, :�. Premium. ..?,'G- ............. Situated in the town of.... rr?.Lt.�[n. ..... CaN uiya County, N. V. I low many acres of land in the place? ................ What is the value of the land and buildings? $......... . . . . . . . . . Of what material is the house?. ;.-4_0e�ow old is it? ............ years. How many stories?.. ......... For what is it occupied? ............ By whom? .................. Is it painted outside;;1_.4! ... Inside? ........ In what repair?.......... Is the Ist story plastered?. ......2nd story?...... , •Are the chimneys all of brick? ...... Are they in good condition?..... . How high above the roof is the loweit? .... ft. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in ................................ Barns —Material How Old Cover of Roof Condition How Finished Painted No. I .............. ...................... ... ..... No. 2................... ...... ................ ... ...... .................... ......... ...... ...,..................................................... .................. ...... No. 3............................................................................................................................................... ......................... ................................................... ...... .... ........... .......... .........i............. .................. I .. ........... ...... ........................ Loss, if any, on buildings, payable to........................................................................................................................... .......................................................................................................as.............. ...... .... ...... Interest ...... may appear. w Has the Applicant ever had a fire? ......... I f so give origin and explanation................ .......................... ......................Has the applicant any special reason to fear fire from incendiarism?. .........Is there any other insurance on this property, or any other exposed with it, in this Company ................if so, state amount $ ..................Name of insured ............................................................ No. of Policy ............ Is there any insurance in any other Company?.....................It so, state amount and what it covers, on back. What is your title or interest in the property? .............................................................................................................................How much is it encumbered? $................... In Consideration of the Insurance, obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL. INDEMNITY .ASSOCIATION, of CAYUGA COUNTY, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my Membership Given in pursuance of Section 7 of the Act under which the Association is organized, and in conformity with the By -Laws of the Association. ..................................................... ... .... .. ...........................APPLICANT. THE SOLICITOR WILL PLEASE ANSWER THE FOLLOWING QUESTIONS: Have you carefully examined the above risk?......... When did you last examine it? ................................ Did you then inspect the chimneys and pipes where they pass through partitions and floors, and enter chimneys? ............. Are they all apparently safe? ............ Do you know of any acts creating a m al hazard? �// v DATED ... ... ... ........ !..`r....: .....I907 .......... .:,..... ...... .. , .. .....SOLICITOR• i� _t � ,• •��` `�,�,r,�� Material of house No. 2............................. Age ............ years. In what repair?................................ Is it necessary and o remunerative in its present condition ?...........t.,. Is it painted ?............... .. Is it plastered ?............ , a� ,.. Are the stoves �' THE FARMERS'MUTUAL apipes and chimney$ in good condition and apparently safe ?.................... Where and how are ashes kept ?........................ 0 ......... ............................... ... ............................SOLICITOR. .n a EM ASSOCIATION EASTINDNITY.� O of Cayuga County GO APPLICATION OF ..... `'171 � R. D../.............. bID County of..,.. ... 3 0 CIS l +� State of ... �•rt..�..e.J'. .... Town of......� .. .. _`!...... m Premium.............................�..�!.�. Discount for approved to o H ° y- Lightning Rods..... .............. ................ Total....................................�..� ......... Date of Risk. .... .... .........182.y Ticne... .......years. C3 .� ..�.. .. ./.....64wk ......... .. •., SOLICITOR. VV Renewal of Police No..G?! .. ......... Reinsured No ............. ..... O� •v��•tio►1�w�� ♦ • �: WEST ��Itc�atiolt of .1.:....1... :.. .:.....« .... . ,.Y f :..:..:::... ..�' ... � �/!. .-,.,. z...':.. ....... It. F. D., No............ Pok.oflic(�....... �. County of.......... .............. :..,-.,_And State, of New York, !or instirancN against lows or- damage by fire or- lightning ill THE FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. V. for the terra of .................. years from the............ day of. .......I92..,A; at noo:a, to the.... /..... day at noon, on property located on the...............side of......... ....road, .........miles from.............................. .....in the Town -of ............ I...... ..................County of................................... ...::.and State of New York, as follows . A mount Insured .. $..Q.0...On Dwelling House and Attachments .................On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises .. �..''.u. Ora Piano $ .................On Organ �................. On Phonograph and Records $..................Oil....................................... $... ..Q.d.....Oil L'arn No. 1 $ .................On Larn No. 2 $ ..................On Barn No. 3 ................On Barn No. 4 +..................On Hog House .................On Hen House A mou t►t Insured $ ..................On Corn f_iarn or Granary $ .................On Produce on Premises �5................. On Farming Utensils, Carriages, Sleighs, Lobes, Harness and Automobiles $.................0n Horseq $ ..................On Catt le . ............ ..On Registered Cattle $.:. ..............On Sheep $. .................On Fowls $ .................On Swine $ .................Orr........................................................ $....... .........On ...................... ............................... $..,QQ-0.Jotal ............ Rate ......... Premium flow many acres of land in this place?!'jt/r777_0'*What is the value of the land and buildings? How many stories in dwelling house?../ V/zz... By whom occupied? �...,�.�t.c';.. � � �.J�,..��•:�Is i ainted outside?. --� Inside ?... )6<-.d.... Is the first story plastered ?. -,A�e... Second story ?.. Are the chimneys all of brick ? ..... Are they in good condition? .... V.S.4......... How high above the roof is the lowest? ................... feet. The pipes are in good con►}itioua, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in...... :P.......................................... Value Material How Old? Cover Roof Condition Painted � SIZE OF' BUILDIINGS Height of Posts liouse........ ............... .................................................................... ........ X........ a ........ .X...... llar'tl N(1. 1. ................ .................. ................. ........ ........ ........ .... I ......... X........ .a . .......� I1arnNo. 2. $. .................................................................................................. ! x ...... ........... BartiNo. 3.. $ ..................................................................................... ..................... i......... Y.........a......... x...... .............. ......... ......................... ............... ................. ......... ........ .................. ..................... i ......... x ........ a..... . x ..... .............. Loss, if any on buildings, payable to......�a .�.�......... ; .....4-; .....E,;'� .. ! ............ .................................Mortgagee......, as..../414�... Interest...... may appear. \Vhat buildings, if any, are equipped with lightning rods?..4?." "��'::✓... � :�::L � Name of manufacturer? ............................................................. Date installed ? .......................... Are all ground connections satisfactory 9............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings .$.............. Has the Applicant ever had n fire?AP&47___... If so, give origin and explanation ............................................ Has the Applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or any other exposed with it, in this company ?..efteLt''. If so, state amount $.............. Name of Insured.......................................... No. of Policx .................. Is there any other Insurance in any other Company?. If so, state amount and what it covers, on back. What is your title or interest in the property ?.. a,?yr.-�.... '.......... How mucli is it encumbered ? ,fD.. a—:.:.. --! ................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' ]MUTUAL INDEMNITY ASSOCIATION, of Cayuga. County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act ender which the Association i9 organized and in conformity with the By -Laws of the Association. _- �'.......... '......^... . /�J/....Ad:/ Applicant. The Solicitor will please answer the following Questions :— Have you carefarlly examined the above, risk? .............. When did you inspect the risk inside and outside ?.......................... Did you then inspect the chin-aneys and pipes where they pass through partitions arid floors and enter chimneys? .................. Are they apparently safe? .................. Do you know of any facts creating moral Ijazard ?............ ..... .- ................... ..;...�.... ,r .... ...... I................ ;011citor. • Nti1.�Ir1�11tiN �� • FARMERS' MUTUAL INDEMNITY ASSOCIATION of a CayugCountyl moo. __J��y ___---_____-_____ APPLICATION OF ............................................................... ......................................R. D............... .. Countyof ............................................... Stateof ................................................. Townof ......................... ..................... Premium .. SnrveyFee.......................... $................. Total.................................. $........ ......... Date of Risk.... ............. .................1�)1.:. Time ....................... years. ...................... ....................................... SOLICITOR. Renewal of Policy No ............................ Reinsured No ........................................... Material of house No. 2................................ Age ............... years. In what repair ? ...... ................... Is it necessary and remunerative in its present condition ?.................... Is it painted ?....................... Is it plastered? Are the stoves, pipes and cliimneys in good condition and apparently safe ?.......................... Where and how are ashes kept ?.................................. ........................................................................... SOLICITOR. East c� U W U 0.? 1 H � o r z a H d' a c 0 c 0 0 ipplfcation of ........................................ ........ ................ R. 1!. D. No............. Postoillee....................................... County of ..................................................and State of New York, for insurance against loos (,r damage by fire or lightning in the FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga. County, N. V. for the term of ...... ......... years from the ............... day of ........................ 191...at noon, to the .............. day of...: ................. 19..:.. at noon, on property located in the town of...............................................County of Cayuga and State of Now York, as follows: Arnorrnt \'alrre of Height SIZE 01+ BUILDINGS Insured 13nridings of Posts On D«elling House and Attachments ............................... I$ .............. .............. '............... ..... ...... x ...........a ...........x ............ I � On Household Furniture, Provisions and «'earing Aplrrrel therein and on premises ................................................ ...... Orr Piano, $......... Organ, $... .... Melodeon, $......... therein ............•••. On Printed Books, Pictures, 'ilver and Plate therein.. On......... ... .. ....................... OnBarn No. l.............................................. ..... .... ........ ...... ........................ a ............ x............ OilBarn No.2................................................................................' .... ........ ....................... x ............ a............ h............ On'Barn No. 3........................................... ..........X ............a............ x.......... On Barn No. 4. .......... x ............................................................'.... I..................................x.............rl........... ............ OnCorn Barn or Granary............................................................ . .................... ................... x ............a............ x........:... On Produce in said Barns and on Premises .........................................: I'ii 1: S F`1TT N0. OF Ah'I1IAf,S Oil.................................................... .......................... ............ ............... ....... ....... Hisses............... Cattle............... i On Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep Fowls...... in -said buildings and on Premises......... ...... INDIVIDUAL LIMIT ON i............... On Live Stock, On Horses, $......... Oil Cattle, $......... ( I Horses $ ...............Cattle $............. to -wit . On Sheep, $....... On Fowls, $......... ..............I sheep $.................. Fowls $.............. Mate. .. ................................................ Total, - I ....... - - I Premium ................... ...... Situated in the town of................................Cayuga County, N. Y. How many acres of land in this place ?............ What is the value of the land and buildings ? $................. Of what material is the house ?....... .............. How old is it ? ............years. I -logy many stories ?............ For what is it occupied ?................. By whom ?........................... Is it painted outside ? ........... I nsid(e ?............... In what repair ?.................. Is the first story plastered ?............... Second story ?............Are the chimneys all of brick ?......... Are they in good condition ?...., How high above the roof is the lowest ?........ feet. The pipes are in food condition, safely ,ectired and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in............ Barns —Material. How Old ? Cover of Roof. Condition. How Finished ? Painted. o), I ................... .......................... ................ ......... ..... ......... ............................... ........................... No. 2.............................................. .... .................. ...... ................ ......................... .............................. .................. No. 3.................................................................................................................................................... ....... ........ ................................................. ................. .......................... . Loss, if any on buildings, Payable to ..................... .......................... ................................................................................... ................ ................ .......... .as. . Interest may appear. Has the Applicant ever had a firm ?.............. If st), give origin and e xphination....................................... 1-las the Applicant any special reason to fear fire from incendlarisrn ?............ Is there any other Insurance on this property, or anY o0jer exposed with it, in this; Company ?............ If so>, state amount $............ Narue of In,,ured..........................................�'o. of Iolicy.................. Is there any Insurance in any other C-mp`hny ?............ If so, state amount acid what it covers, oil back. Wit.rt is your title or interest in the property ?........................................................... How much is it encumbered ? $.................................... In Consideration of the Insurance obtained on property narnvA, I do hereby give my Undertaking, wiwreby I bind rnysc•lf and my heirs, executors, administrators and assigns to pay to the said FARh1ERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pl*o rata share of all liabilities incurred by the Association, and all losse3 by Fire or 1,i6htnins, sustained by auy rne►ubcr thereof, during my rnernbership. Given in pursuance of Section 7 of the Act under whi(;h the Association is organ - zed and in conformity with the By -Lays of the Association. ................................................................................................... .............. Applicant. The Solicitor will please ans�Ner the folb),xing Q iestions:— 1 lava you careftilly examined the alr)ve risk ?............ When did you last examine it ? ............................... li'd i ,u t inspect you then the chi1nn0ys and pips s where they pass through p.l.rtitions and floors and enter chimneys ?...................Are they apparently safe ? .................. Do you know of any acts creating moral hazard ?............ Dateof Inspection .............................................19 L. ..................................................................... f THE FARMERS' MUTUAL ; INDEMNITY ASSOCIATION of Cayuga County IR o F --------- I, ION� �UP�/. Sd --- 4 /-- 47 Z2 ------------- Date of Risk...J. �--- . ...... / .. .......... 192J. 6 ........... years SOLICITOR. Renewal of Policy No.I. V...f. p..u..-...... � Reinsured No ........................................... Material of house No. ............................... Age ............ years. In what repair?................................ Is it necessary and remunerative in its present condition? .................. Is it painted ?..... ............ Is it plastered Are the stoves, pipes and chimneys in good condition and apparently safe ?....................... Where and how are ashes kept ?........................ iw 410 .......................................................................... SOLICITOR. FAST ISHM Ce 0 0 a a e� 4a c Cz O 0 Ci :.c 3 bA _C _b D rc 0 EpplicationOt........... j.......... .a............................s............. R. F. D., No............ Postofiice...................................... Countv of .......................................... and State of New York, for insurance against loss or damage by fire or lightning ill THE FARMERS' MUTUAL INDEMNITY --.ASSOCIATION, of Cayuga County, N. Y,o for the term of ............ ..... years from the ...... :....day of.............•........lp2j. at noon, to the .....:....day ...:"'....1�`'...` at noon, on property located on the...............side of .................. road , .........miles from .. .......... ...................rn the town. of ....................................County of .................................... and State of New York, ae follows .— Amount Insured $ ..................On Dwelling House and Attachments .�7 Books, $............. .On Household Furniture, Printed Pictures, Silver and Plate, Provisions and Nearing Apparel on premises. $....,1..:::...'....On Piano ; $ ...............Organ ; $.............. Melodeon. $..................On.......................................................... $.................On......................................................... $ ..................On Barn No. 1 $ ..................On Barn No. 2 $ ..................On Barn No. 3 $ ..................On Barn No. 4 $ ..................On Hog House $ ..................On Hen House Amount Insured $ ..................On Corn Barn or Granary $..........�-..J_On Produce on Premises $...... ........... On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles on premises $ ..................On Horses $............. !,rf..On Cattle $.................. On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On........................................................ $..................On......................................................... $...:::...:... :..Total ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings ? $..... ........... How marry stories in dwelling house ?............ By whom occupied?...................................................... s it painted outside?Inside I pa �`' ? ............... In what repair ?.................. Is the first story plastered ................ Second story? .................. Are the, chimneys all of brick? ......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value flow (old ? Cover ]tiuuf Cmidit,iurr IIow Finished Painted SIZE OF BUILDINGS Height of Posts House......... $ ......... ............... .................................................... .................------ x------ a ------ x------------- BarnNo. L. $....................... ....... ................ .......................................................------ x------a-- - x-- -- -------- BarnNo. 2..$................................ ......................................................................------ Y------ a ------ x------------- barnNo. 3.. $ ............................. ................ .......................................................------- x------ a ------ x ------------ ..................$................................................ ......................................................------ x------ a ------ x------------- Loss, if any on buildings, payable to--------------------------------------------------------------------------------------- I'Iortgagee----, as -------------- Interest---- may appear. What buildings, if any, are equipped with lightning rods?.............................................................. Name of manufacturer ? .............................................................. Date installed ?....................... Are all ground connections satisfactory? ............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $............. Has the Applicant ever had a fire? ............... If so, give origin and explanation............................................ this the Applicant any special reason to fear fire from incendiaristn ? .............. Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Insured ....................................... No. of Policy............... Is there any Insurance in any other Company? ............ If so, state amount and what it covers, on back. `Chat is your title or interest in the property ? .................................................. flow cnrtc is it encumbered? ......................................... �l h $. In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section ; of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ..................................................................... APpl i ea n t . The Solicitor will please answer the following (questions :— Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?.. .... ................... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently safe? ................. Do you know of any acts creating moral hazard? .................. ........ .......................... Solicitor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County APPLI TION OF 0 ........ ............... 0 County of.... ... ......... .. State of....... .... ......... _-- - .......... 0 Town of. .. .......... U f $--- Premium............................................. Discount for approved Lightning Rods ............... Total.................................... •'-:. Date of Risk ................ Time ........... r .............. .............. LICITOR. 0 Renewal of Policy No. �� ,....._. A•` . A'� qvw. Reinsured No ............... .. ....... Material of house No. 2...... ......................... Age ........,..years. In what repair?................................ Is it necessary and remunerative in its present condition ?.................. Is it painted? ................. Is it plastered? ................ Are the stoves, pipes and chimneys in good condition and apparently safe? .................... Where and how are ashes kept ?........................... " W W W ....................................................................... SOLICITOR. EAST WEST ce 0 ao � r 'Loll ........... It. F. D., No............ Postofli............................................ of.......:.........................and State f New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of. ears front thc-a.15.. day of .....................19:0 at noon, to ther�..0 ...day of........ •••• tqj .. .........3 �%>a M6O ...........side of..................road. .........miles from....................................ul the Town of _ n, on property located on the.... � o /4 /� ��and ,State of New York, as follows:— ..... ...........County of.l........ ............... Amount Amount Insured Insured ..................Oil Dwelling House and Attachments Y. ... �...On Household Furniture, Printed Boots, Pictures, Silver and Plate,, Provisions and Nearing Apparel oil premises $............... On Piano $ .................On Organ ..................On Phonograph and RecordQ $+.................Oil...................................................... $ ..................Oil BarIl No. l $. ................Oil Barn No. 2 ..................Oil Barn No. 3 ................On Barn No. 4 $... ...............On Hog House .................Oil Hen House $ .................On Corn Barn or Granary gyp .............. On Produce on Premises On Farming Utensils Carriages Sleighs. Robes, Harness and Automobiles ... '�..On Horses ..................On Cattle .............On Registered Cattle $... ..............On Sheep ................On Fowls gy: ...............On Swine s...............On...................................................... ...... .........Oil ......................... ..... 10 .................Total ............Rate .......... Premium How many acres of land in this place :'............ What is the value of the land and buildings ? $............ How many stories in dwelling house? .............. By whore occupied?....................... Is it painted outside?. Inside ? ........ Is the first story plastered'? .............. Second story? ............... Are the chimneys all of brick? ........ ........ Are they in good condition? ................ How high above the roof is the lowest? .................. feet. The pipes are in good condition, safely secured and enter they chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .............. .............................. Value Material How Old? i Cover Roof Condition I Painted SIZE OF BUILDINGS Height of Posts House........ $............... ..............................................................I .............................. x......... a ......... x...... ....... BarnNo. L.$.................................. ............... ................. ......... x......... a ......... x ..... .............. i BarnNo. 2.. $..................................................%................. .............. ;....................... .........x ........ a, ......... x...... ............. Barn -No. 3..$................................................... j.................. ........... ...... ..............................x.........a.........x...... .............. ..................$...............................,...................................;.................... .........x ........a..... .X....... ............. Loss, if any on buildings, payable to................................................................................................. .......................... ...... Mortgagee..... , as ............... Interest ..... may appear. What bnildings, if any, are egiiipped with lightning rods? ................................ ................. ............ Name of annfacturer c.� ............................................................. Pate installed ? .......................... Are all ground connections satisfactory ?............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $.............. Has the Applicant ever had a fire? ............... If so, give origin and explanation........................................... Has the Applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or any other exposed with it, in this Company ?............ If so, state amount $.............. Name of Insured ......................................... No. of Policy................. Is there any other Insurance in any other Company? ......... If so, state amount and what it covers, on back. What is your title or interest in the property ? ......................................... How inuch is it encumbered? ............................ ................. ..... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assi{rns to pay to the said FARMERS' MUTUAL IRDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, daring my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in, conformity with the By -Laws of the Association. ............................................................. Applicant. The Solicitor will please answer the Following Questions: — Have you carefully examined the above risk? .............. When did you inspect the risk inside and outside?. ........ Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently safe? .................. Do you know of any facts creating moral hazard? ........... ...... ............................................................. Solicitor. •�ww��ww w�ww4 FARMERS MUTUAL INDEMNITY ASSOCIATION of Cayuga County r-rrrrrrrrraroom�oraG� e n �, n r �i e m r-p�--^-----ocoomaomoorr ORA rrrrrrroaca^�^�^�^��,�,00momomm,- ^mmomoao APP I ION O .. .........�. .. ..... .. R. D..�� ... County of .. ... ..... .. State of .... . . ... ... .... Townof.............J................... rxaorrannrrrrrore^^^^^^^^^floroomrramooe�^^^^^^^^e000rr•, "` rcrmooaaormcmrrrmr oorarrirrar000aaorr, Premium .. ...............n ... ........ Survey Fee ................ .............. Total................... .......... momammmoaomomoc . ^ � .,, � ° oommor,,momommomoor tr . Date Risk..Q)I- . ../�.4? . .......19121 Time .... ......... years. mmmmooramaco�om00000amommomoaarormommmmor . j. ..................... SOLICITOR. n0000nmooaommmoerioomoomr�ori000amamromnaoemromrr Renewal of Policy No.. , , .'� . ........... Reinsured No. ............................ AAAAAA O~ AAM •/��AMIV� AM /1AAAO Material of House No. 2 ? ............. ............ A ge ..... • .. years. In what repair? ...................... Is it necessary and remunerative in its present condition ? ..............Is it painted ?................ Is it plastered ?.......... Are the stoves, pipes and chimneys in good condition and apparently safe? ................ Where and how are ashes kept ?................ ......... . A Cd U U . O O O 1 z . W F•" O e 4( � Q a U U . a O O O i is ................................................... SOLICITOR East 4seAA, r• V. O a U c� Cd CS ce ., rd ED: 0 .Cd R, 3 0 ce O W 0 A a 0 3 r m b m .. On.......................... .......... ....... ........ ........ On Farm Utensils, Carriages, Sleighs, Robes and Harnesses �tL� I 7 RovItcatton of..... ..... ............ t.................................... .. . R. F. D. No.P. O., . ........ . . . . ............... .County of. , , • , . , .. , , , , , . State of New York, for insurance against loss or dame b Fire or Lightning in the Farmers' Mutual Indemnity Association, of Cayuga County, No Y., in the sum of !� p.. ..'............ ...... .... ...... .... ..... . .... ... ...... ..... . . . .. . .. .. DOLLARS, for the terra of...`....... years, to wit: i i�l. I . ..ii � r il4 Ill ii II I .. .: �u:___�... .. .�i ....i .... .i li.. L. .......I .I II��Mr�il. .. _I. ��. ....I.�. i. .. ... .. � � .u..�1-4. 4�� ii.. i. i.. �i rnu• II.I .. r.. ill. .i Y�. urlu .iii� .. .�. 4_Inir. .. Amount Value of ai height ` SIZE OF BUII.DIIG Insured Buildings of Posts On Dwelling House and Attachments.. ....................... !a......... �........ ......... ........ Y*........ a........ x........ . On Household Furniture, Provisions and Wearing Apparel therein and on premises ..................... , , , , , • , , . i On Piano, 5........Organ, S. Q.. , ...... therein! ... V.- On Printed Books, Fictures, Silv.r and Plate therein............ �Q On.......................... :. ...�..` � • j ......... ......... I ...... Qn Barn No, 1...:.... .. :.:., . .......... ........ On Barn No. 2.................. OnBarn No. 3............................................ .......... '.......... �.... .... OnBarn No. 4............................................ .......... .......... ........ , On Corn Barn or Granary ................................... ......... .......... ........ . On Produce in said Barns anti on Premises .. . . .. . .. . . . . . . . ... , , , I i PRESENT i10. OF ANIMALS, .... .. 'Horses. .. .... Cattle.. is ...... Sheep ............. Fowls. ,`qA .... . I ....:..x........a........x......... .......x........a........x......... ........x........ a ........ x....... 0. .......x........ a ........ x......... .......X ....... a ........ x......... in said buildings and on premises ....................... . . . . . . INDIVIDU.IL LIMIT ON On Live Stock On Hones, 5. Cattle, . , j j� , , (Horses .. Cattle $... ....... to wit: On Sheep, S.......... Fowls, ... �� ... ... 'w.n... ......... Sheep $ . Fowls $ . ~� mate .............................. Total, Premium. ....................... �. .. ! � Situated in the town of g �� Cayu�1 County, N. Y. llow many a:�res of land in the place?. .. ............. What is the value of the land and buildings ? .................. Of what material i"thheh.ous .... How old is it ?... ...... years. How many stories ,�2�.... For what is it occupied ? ..,..Py whom?..... Is it painted outside? . In what G,��. Inside �'.�,,. repair . Is the 1st story plastered ? . .. 2nd story ? , • , , Are the chinine s all of brick Are the in good condition ? ..... . p ? Y P � Y• � 3' Y g How high above the roof is the '.owest?, , . ft. The pipes are in go- d condition, safely secured an enter the chimney horizontally by a thimble or are firmly cemented therein. All wood as'ies arc kept at least thirty feet from any insured building or in. .. . .................... Barns —Material How Old Cover of hoof. Condition. IIow Finished. Painted. No. i .......... .... . . .... ............. .... ............... .................................................................................... No. 2..... ......................... �'. ............. ............. ..... .. ........ ................................................................................... No. 3 ............................................ ......................... .................................................................................................... ...................................................... ......................... .................................................. .....,............................................. c_ Loss, if any, on buildings, payable to.............`............................................... ................ r . .................................................................I............0 ...................... as ......... ...................... Interest .... . .may appear. Has the Applicant ever had a fire ?... .....If so give origin and explanation..............................................................Has the applicant any special reason to fear fire from incendiarism 411P....Is there any other insuranc on t 's property, r any other exposed with it, in this Company ? .�.........If so, state amount S............... ..Name of insured.,..1.r.,.........4.. ... .. ...........No, of Policy/�/.,,�1,,,,Is there any insurance in any other Company?....1.'[!A.........If so, state amount and what it covers, on back. What is your title or interest in the property? ....................................................................................................................How much is it encumbered? S .......................... ... In Consideration of the insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOOIATION, of Cayuga County, N. Y., my pro rata sliare of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership Given in pursuance of Section 7 of the Act under which the Association is organized, and in co formity with the By -Laws of the Association .............................. ................. ................... I ............................ 0............,............ ... ........... APPLICANT. The Solicitor will please answer the following questions: Have you carefully examined t'ie above risk?........... When did you last examine it ? ...............................Did you then inspect the chimneys and pipes where they pass through partitions and floors, and enter chimneys ?............Are they all apparently safe ?............Do you know of any acts creating a moral hazard ? Dated.........................................191...... ........ ................. ............... #................. .... ...................... SOLICITOR. 0 ftv*Ako1ft4%1s-s a 0 THE FA RMERS UTUAL0M 0 00 INDEMNITY ASSOCIATION '0 0 0 of County Cay� u a10 0 0 0 �O.-___-_-a- -- _________ _ 0 . 0 0 0 0 APP ION F 0 0 .... ............ 0 0 .. R. D. .............. County a�f. ... ... ....................... 0 State of......... ................................. . 0 Towno ..................................... 0 ------------------------ 0 Premium........................... $..... ............ r 0 Survey Fee ........................... $.................. 0 Total.................................... 0 Date of Ri .. .......... ..�.192d 0 Time. ..... .years. $0 .... .. .. SOLICITOR. 0 Renewal of Policy No .............................. Reinsured No........ 0 Material of house No. 2................................. Age ............ years. In what repair?........ ..... Is it necessa ................... ry and remunerative in its present condition? .................. Is it painted? ..... ............ Is it plastered? .................. Are the stoves, pipes and chimneys in good condition and apparently safe? ....................... `'Where and how are ashes kept? ........................ ......................................................................... SOLICITOR. EAST V � O O z H A W ZippItcation of. - .... .. P. 1'. D. No ............. Post e.............................-:1... Countv •- . .......••• and State of New York, for insurance against loss or damage by fire or lightning in 'THE FARMERS' MUTUAL INDEM TV ASSOCIATION, of Cayuga County, V. for the term cif;.... ........ vears from the... •.day ..................... 19` P at noo e . day ............... 192 �- r� at noon, on property located on the...:... T.. ide of..................road, //"Yniles fro ......................... ........in the town o .:��... .: ...:.........County of P:.:. �:- • � •• `.... ....gad State of New York, as follows .— .. Amount Amount Insured Insured ......On Dwelling House and Attachments $.................. On Corn Barn or Granary $ ..................On Household Furniture, Printed Books, $.................. On Produce on Premises Pictures, Silver and Plate, Provisions $...... ........... On Farming Utensils, Carriages, Sleighs. and Nearing Apparel on premises. Robes, Harness and Automobiles on $... .............On Piano ; $............... Organ ; $.............. premises Melodeon. .On Horses $ .................. On. .................................. 0..................... . $.................. On Cattle $.................On......................... ..................... ......7 �, _ -- - $..................On Registered Cattle $ ...:..............On Barn No. 1 ±"�- -r �, y $ ..................On Sheep $ ..................On Barn No. 2 $ ..................On Fowls $ ..................On Barn No. 3 $ ..................On Barn No. 4$.................. On ...... ..... .... ....... . ................ ................. $ ..................On Ilog House $ ................. .On ........................................ ................. $ ..................On Hen House $.................. Total ............Rate ................Premium How many acres of land in this place ?....... ..... What is the value of the land and buildings? $..... ........... How many stories .................................... Is it painted outsidc� . in dwelling horse ?.. •.•.....: By whom occupied?..... ... .... .._ .... Insidc. ?, In what repair ?✓!...... Is the first story plastered ?. .F. Second story ��....... Are the cliinineys �a 1 of bri .....:.2 Are they in good condition .. How high above the roof is the lowest? ...........feet. The pipes are in good con ition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood a,lhes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old? Corer Roof Co►rditiom, II(1w finished Painted SIZE OF BUILDINGS Height of Posts HOu�e........... ............................ ......., .L.:..... •-------x------------x------------- )7zz� T ^��-�l'Zi...... G .. ... :.n...�..... _ __ \ ___ a-------- ar"n O. 1 .. �.....�........... �f�/ BarnNo. 2.................................. ........................................................................------ x------ a ------ x------------- BarnNo. 3.. $ ............................. ..................... ................. 0................------ x------ a------x- ------------ ..........................................................................................................................------ x------ a-----.-x ----- -------- Loss, if any on buildings, payable to ------------------------------------------------------------------------------------- --------------------Ilortgagee--- as -------------- Interest ---- may appear. What buildings, if any, are equipped with lightning rods? ........ ... •........................ ............•••••• ......••• Name of manufacturer? Date installed ?....`' :............... Are all ground connections satisfactory Total insurance on rodded buildings $............... ; 25 per cent discount for rodded buildings $/�L:..�...... Has the Applicant e 'er had a fire? ............... If so, give origin and explanation .................. •....................... Has the Applicant any spt•cial reason to fear fire from ineendiarism ? .............. Is there any other Insurance on this property, or any other exposed with it, in this Company ? .............. If so, state amount $............... Name of Insured....................................... No. of Policy............. Is there any Insurance in any other Company ?. L If so, state amount and what it covers, on back. What is your title or interest in the property ?................... ......... ...................... How much is it encumbered? $............................................ In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and nay heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section ; of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ..................................................................... Applicant. The Solicitor will please answer the following Questions Have you carefully examined the above risk ?. .. When did you inspect the risk inside and outside?. ... ... .... �.... Did you then inspect the chimneys and pip6 where they pass through partitions and floors and enter chimneys? .................. Are the apparently safe � ....... Do you know of any acts creatingA,moral Y PP Y ? •t-•-�•.•• .:Ir.Solicitor. # THE FARMERS' MUTUAL s 0 INDEMNITY ASSOCIATION '0 0 of Cayuga County '0 i 1Ro,----,,�,7-o_0_3_�0 __ $1 YA P]Lie.Pl(lY UI SCounty ol..... .j--Y��r.<99Vc„2.... Town of. ....��L(.... I,Lf, �l„'i.'............. i 1 SSurvey Ftt. S.. ...... SOLI MTOH. Renewal of Policy N o Reinsured Materialof house No. 2................................. Age............ years. In what repair? ........ ........................ Is it necessary and remunerative in its present condition? .................. Is it painted ?..... ............ Is it plastered? .................. Are the stoves, pipes and chimneys in good condition and apparently safe ?....................... Where and how are ashes kept? ........................ U 0 0 0 ran ' W ►�+ H-1 C� ff� Eft (}� ,x a i H A w; • �C d a a 0 0 0 O � 1 1 � .........................................................................SOLICITOR. EAST M A, M O ri +-3 t4 EppItcatfo.. ..:�, .:�.... .............. R. F. D., No........... Fostoffi ..... ... ... 7 .....-f.�.. and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the term of ................ years from the..... .....da.y of........,., ...........192... at noon, to t e .........day of..................19?... at noon, o progry tlocated on the .....side ..�.............. road, .....miles fror ..................in the town of ` .................arid State of New York, as follows: --- �.... located of.....�: Y. Amount Insured $ ..................On Dwelling House and Attachments $.................. On Household Furniture, Printed Books, l: Pictures, Silver and Plate, Provisions and Wearing Apparel on premises. , $.................. On Piano ; $ ...............Organ ; $...........,11 . Melodeon. Uk! $..................On................................................, $.. .............On........................................ .....:..:... 's � - t .................On Barn No. 1 4!,/ 3 � $ ..................On Barn No. 2 $ ..................On Barn No. 3 $ ..................On Barn No. 4 $ ..................On Hog House $ ..................On Hen House Amount Insured $ ..................On Corn Barn or Granary $ ..................On Produce on Premises $ .................On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles on premises $ ..................On Horses • $ .................On Cattle $.................. On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On........................................................ $..................On......................................................... $ ..................Total ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $..... ........... How many stories in dwelling house ?..:.. By whom ccupied?:::.............................. Is it painted outside ? ..�.... Inside? Is the first story plastered ?.... .. .. Second story `� . .,:e%.,%..... Are the chimneys .... In what repair? ., all of brick ?. ... Are they in good edition ?. How high a ve the roof is the lowest ?��.�.�'...feet. The pipes are in good condition, safely secured and enter the chic ey horizontally by a thimble or are firmly cemented therein. All wood a.hes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height of Posts . ... _-_-X--,-r a------x----- ...... .. ... ...... .... ............------ x------ `a-----`L----- -`-' -- �f BarnNo. 2..$ ............................... .......................................................................------ x------ a ------ x ----- -------- BarnNo. 3.. $ ................... ...............................------ x------ a ------ X----- - ------ .................. $..•............................................................. ...... .. ... I ........... .................. ------ x------ a ------ x------------- Loss, if any on buildings, payable to--------------------------------------------------_--------------------------------- --------------------rlortgagee_---, as -------------- Interest-_-_ may appear. What buildings, if any, are equipped with lightning rods?............................................................... Name of manufacturer? ' Date installed ?........................ Are all ground connections satisfactory ?............ .............• ........... ........ .......n...i..v► t Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $........ ..... Has the Applicant ever had a fire? ............... If so, give origin and explanation............................................ Has the AI_)plicant any spf-cial reason to fear fire from incendiarism ? .............. I�s there any other Insurance on this property, or any other exposed with it, in this Company ? .............. If so, state amount $............... Name of Insured ....................................... No. of Policy............... Is there any Insurance in any other Company? ............ If so, state amount and what it covers, on back. What is your title or interest in the property ? ........... ....................................... How much is it encumbered? $............................................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertakin,6, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my rnernbership. Given in pursuance of Section 7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ..................................... ................................ Applicant. The Solicitor will please answer the following Questibns Have you carefully examined the above risk?. When did you inspect the risk inside and outside?. ......... Did you then inspect the chimneys and pip where they pass through partitions and floors and enter chimneys ?.................. Are they apparently safe? .r:r::::. Do you know of any acts creating moral Solicitor. ...... :4 .y!:.....................:.........::...:..... ...... . MUTUAL TIDE FARMERS' INDEMNITY ASSOCIATION � of Cayuga County -- - � -------- APPLICATION OF - ....... .... ...... ...... .. R. D...... ............. . County of..... State of ....... . .................. . Town of.:...�✓/ .. L ::::�-. _........ ..... Premium.............................. $.................. Discount for approved Lightning Rods..... .............. $... ./...... Total.................................... -`....`....... Pate of R•iek / .............0? ........... 191� Time ...................... years. ....... ............. SOLICITOR. .Renewal of Policy No.,a:...../..�.�...... b � d Reinsured No....... ` • oft Material of house No. 2............................. Age ............ years. In what repair ?................................ Is it necessary .and o remunerative in its present condition ?............... Is it painted ?............... Is it plastered ?............... Are the stoves, _ a pipes and chimneys in good condition and apparently safe ?......... Where and how are ashes kept ?.. ......................................... ... ............................SOLICITOR. FAST, 40 In F v N J � C • � b a .... U y � b � O a � J l � s A . - - .- - .. .. ... ..., •. . ...._ . s.. r, • •a/ila.w.s n.r�w�.'Y.....+�Mr a.."+"m's.tslxaW�.+�u•..+L°•bs'►av!' 'a. • W RPP1tCatto 0 t.2:. ...Gyt..... "..,.... ::.................... R. K D... ...... Com1t�• o ..� /: ....�:.tr:.y". icl Suiteof 1Te �y York, for insurance against loss or dan► _ ge by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. at noon, to the f F rc fror►�day of. L r1''�:�, e*day (or th( term of .... .... .. vea .... ... ...... ........ I at noon an ro arty located on tl►e:....�. `...side i►f �..:�:::`.:: - ad,/f�-..n►ilesa from.�!.c.:�`.....in the cTown of p p - � oilow, :......... ................C('untl'..... ...dlld State of New YUI')t, as f A mount Insured ....Ott Dwelling House and Attachments .'�..L'....On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises ....�j�..�!. .On Piano ........ ........On Organ ..... j' .:� .. On Phonograph and Record; . f . g% .. % ..... 0 r1% ... a1ia EEC ......... .................. a2 c'`' ......... On Barn No. 2 r�=. ...., .:...:'...... On Bnrrr-i' . .61...... On Barr-N-o: 4-. ....:�..�.....On Hog House .... .....On Hen House Amount Insured $ ..................On Corn Barn or Granary i�....C)n Produce on Premises on Farming Utensils, Carriages, Sleighs, Robes, HarneQs and Automobiles $.... �� .e7/ ..On Horses �.... :un Cattle/ ..............On Registered Cattle, $ ..................On Sheep $.................. On Fowls .................oil Swint' ,. .................On...::. .:.....::.:.'...:....:.::.......... .......... y�+... ...(�IYG•. ..�..:....i.� ::. :. :,,y ..'".:'................ 'J�...Total ............Rate ........... premium How n►auy acres of land in this place?�L.'.L .. What is the value of the land and buildings? $... ........ How many stories in dwelling house? .... ........ By whom occupied! ............. G�- .. �........................... Is it painted outside ?....�. �7• Inside Is the first story plastered `r :.::...t..... Second story?.,,,,.�.� ... Are the chimneys all of brick.- .-. Are they in good condition? ..................... .How high above the roof is the lowest? .................. feet. The pipes are in good condition, safely secured and enter the chin►ney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .................................................. ..... Value Material How Old? Cover Roof Condition Painted SIZE OF BI7 LDINGS Height �- of Posts House....... ............... ..... .............................................................. ..................... '%....xC.�FA�., a .e�l..x�� 1. ......� .........x.........a.........x .... .............. • ........................... ............................... �... .a................ i.....1..2 - 11arn' 1� o. 2.. $............ . BarryNo. :3.. $...................................................................................... .............................. x......... a ......... x...... ; _........... x.........a...., ..x ..... ............. ...............$........................................................................................ i ......... ; Loss, if any on buildings, payable to................E ....... ..!.1.. t:.1....>,,.......................................................... ................................. 1VlortgaLree....... as................ interest...... may appear. r What buildings, if any, are equipped with lightning rods?................................................................. am cturer . Name of ma 1t1 a r R .................................................. Date installed ?..... .............. ........ Are all ground connections Fatisfactory ?............ Total insurance on rodded buildings $........ `...... . 25 per cent discount for nodded buildings $.............. Has the Applicant ever had a fare ?............... If so, ►e a. give origin and explanation............................................. Hag .l 1 t Applicant any special reason to fear fire from incendiarism ?..�:.......... Is there any other Insurance on this property, or any other exposed with i�tn this Company ?-i-v .... If so, state an;ount $.............. Name of Insured ........................................ No. of Policy.................. Is there any other Insurance in any other Co npany ?/!.....� If so, state amount and what it covers, on back. What is your ? :..:-...... ....... How much is it encumbered? title or interest to the property .../..... ... ..... In Consideration, of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind my -elf and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or LightninZ, sustained by anv member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ,�:.,. -... h-u.: ,.'...........-... .................... Applipant. The Solicitor will please answer the following Questions Have you carefully examined the above risk? .............. When did you inspect the risk inside and outside?......................... Did von. then inspect. the chirimeNs and pipes where they pass through partitions and floors and enter clihnneys?.................. Do you know of an facts creating mo 1 raz Are they apparentl v safe ? .. . • _ Y / g ................ Solicitor, s qkAqlbl�� ►�v�. qke% •4%Wti4%WAW w THE FARMERS'MUTUAL T ASSOCIATION INDEf�NI Y of Cayuga County Ino. AP LICAT ON OF ............ ...�r..Y..L . ...�.'`� . . ... �Z:"� ..... R. D. , . ... ...... Count of�:. l 0 State of G .. .............. ..... Town of.... .. Premium.............................. .. . . Discount, for approved Lightning Rods..... .............. .F ... ..... . Tf1tal................................... Date of llisk.-�.. Time ...................... years. �......................�.... SOLICITOR. 0 Renewal of Policy Imo:. ......'.....':C..��.. Reinsured No....... ....'x.... .... :..... :E . • N�1 Nor► NCR ♦•1W-qko,111%WjkW1% 0 ccMaterial of house No. 2............................. Age ............ years. In what repair ?................................ Is it necessary and 0 remunerative in its present condition ?............... Is it painted ?............... .. Is it plastered ?........ , a� ..,.,.. Are the stoves, a pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept ?........................ -a U . r. ............................................ ............................ SOLICITOR. r. 3 LAST 0 0 Z • Ta ago Z64 '� s INA llhh r c E-+ ... ee bo cc -a WEST Rpplicattp of R. F. D_ t, ('ottnty y L ......And Statt� of New York, for insurance anain4 less or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. V. for the term of...�._...........years from ....... day of.....: :....... ........ISM(:,✓, at noon, t„ the...;�....... (.lay of....6%`:`�.:....19:..�. at noon, on 'property located on thc;................side of .................. road . .........►t►ilt�s fr► ln............................. ..... ill the Town of .......... `: ,,. ..0 . ..L.... . c' ► �; , -- and ,tat( «f i�t �� York, a folly ,%mount I n s u xKrl - Dwelling House and Attachments .................On Household ]furniture, Printed Books, Pictures, Silver and. Plate, Provisions and Wearing Apparel on premises .............. .On .Piano .................On Organ ................. On Phonograph and Records ......`: �.. '�...0 ,: . , . ..... ., ...................... .... ....6n. par►1 Vo. $i...... On Barn No. 2 ....... ...4:.. On Barn No. 3 ...... / .J�....On B&rn No.-4 .....` .. d...On Hog House .....v�...e ...On Hen House A rnou r►t Insured $.................. On horn or Granary $ .................On Produce (m Premises ................. On Farming t4ensils, Carriages, Sleighs, I►.ubes, Harne.-a and Atttomobiie4 $..... ............ t On Ilon em $..................OIt C�tt�l� $+ . .............On Hegistered Cattle $ ..................On Sheep $ ..................On Fowls $ ................. Ort Swine o $+....... .... )tt ..................... I ..... ..I ................... ..... t �. ..... G'.TotaI ............Rate ........... premium How ►►►arty acres of land in this place?............ What is the value of the land and buildings? $... ........ How many st(►r•ies in dwelling house? .............. By whom occupied ?....................... .............. .................... Is it painted outside? ............... Inside? ...... ........ Is the first story plastered'► ..... Second story'? ......... Are the. chimneys all of brick? ........ ........ Are t t(,y in good condition? ..................... How high above the roof is the lowest? .................. feet. The pipes are it, good c011dition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at leant thirty feet from any insured building or in .................................... ............... Value Material How Old? Cover Roof Condition Painted SI.ZE OF 13I'II,I)INC7` � Height of Post: 11►►use ....... .............. .................................................................. .. 11arn No. L. $. ...... ........ ........ .........x.........a.........x ..... � ............ .... . I DarnNo. 2.. $........................................................................................................... x ........ a........ z...... ........ 11arnNo. 3..`'.. .......................................................................................................... ..........x.........a.........x...... ..................$................................ .......................................................................... !......... s......... a..... x..... .............. Loss, if ony on buildings, payable to............................................................................................................................... ................................ Mortgagee...... , as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods . .......!� ..`:...:.................. Name of manufacturer'.' ............................................................. Date installed? .......................... Are all ground .onnections satisfactory ?........... Total insurance on rodded buildings $IX.7-J... ; 25 percent discount for rodded buildings $ 7f..P. Has the applicant ever had a fire? ............... If so, give origin and (explanation.................... � .... Ha. the Applicant any special reason to feir fire from incendiarism ?............... Is there any other Insurance on this property, or any other exposed with it, in this Company?............ If co, state amount $.............. Name of Insured ......................................... No. of Poliev......... ........ Is t.1►ere any other Insurance in any other Company? ......... If so, state amount and what it covers, on back. What is vour title or interest in the property'?......................0.................. How much is it encumbered?. ..... ........................................ In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my hairs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., ► y pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by piny member thereof, daring my membership. Given in pursuance of Section oof the Act under which the Association is organized and in conformity with the By -Laws of the Association. ............d ................................................. Applicant. The Solicitor will please answer the following QuestionS :— Have you carefully examined the above risk? .............. AVhen did you inspect the risk inside and outside?..................... . Did you theft inspect the chimneys and pipes where they lass through partitions and floors and enter chimneys?................ Are they apparently cafe? .................. Do you know of any facts creating moral hazard? ........... ...... .......................................................... Solicitor, T • 1��► �� r� Nei• ��►� • THE FARMERSY MUTUAL INDEMNITY ASSOCIATION of Cayuga County 0 moo. , 'z- AI� `I OF 0 ....... 0 •• .... ... ......... 0 - c/ R. D. 0 County of...." ... ......... 0 State of ..... .... ..................... Town. ............................ ..... Premium............ .................$ .................. Discount for approved Light,ni►zg Rods...., .............. ................ . Total ............... ..................��71..�.��.. Date of Risk. ...%... ...?:.:..1�' Time... ..............years. SOLICITOR. Renewal of Policy No'..�%.. ... . Reinsured No ............ ...... ........ Material of house No. 2............................ Age ............ years. In what repair? ........... ..................... Is it necessary and remunerative in its present condition ?................ Is it painted ?............... Is it plastered ?............... Are the stoves, pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept? ........................ ........................................ ... ............................ SOLICITOR. EAST z W U F W 64 .L In H A WEST 'Applicatloll c ....... ,...d .. '.... .... ... ........ C"ount.y of .......................... ....... srid Stereo of N,Aw Yurk, for insurance against loss or dawage hN7 tiro or lightning in THE FARMERS' MUTIJAL INDEMNI V ASS®CIA"TION, of Cayuga County, N. V. for the terra o ....... .... .. f .yc,;rr•s, frr,ni t ..... ila} of ..� .... ]S1 �r,t noui; �o t}ie.s?�. .day o .. .. .. .. !y At no ,r on pro r . %� F ,perty located on . .....arc e o ...............road, �....n►iles frr► ................... in the Town of .�..:: • �: ......Cc,unty o ...... r l............ and State of 'dew- i cork, as follow s-- A iiioun t Amount Irisrrred Insured Dwelling House and Attachments $........ ........ Ors Corn Barn or O rairary- ............. ...On Household Furniture, Printed Bookv $..........(>n Proilnce oil Pictures, Silver and Plate, Provisions ...... Yrerniset� and Nearing Apparel on premises $................. On Farming Utensils, Carriagee, :-;ie°ighs, ....... ..... Orr Piano Robes, Harness and Automc►hile. i; .................On Organ $..... ............ On 1-1orses ................ On Phonograph and Itccords $ ..................On (ratt.le, -$ ..................On.... ..... .............................. ..............Oil Registered Cattle ,�. ...On Kim No. L.}L $ ..................On Sheep .. o� D...Q......On Farm No. $ ..................On Fowls ..................On Barn No. 3 .................On Swine ....... .........On Barn -Nu. 4 ................ Hou House ...... .(4 .....: .U� ...(ln Harr IIousc' �-V D..TotaI ............Rate. ......... Premium Howe many acres of land in this place?............ What is the valise of the land and buildings? $... ........ How massy st,;ries in dwelling house? .... Z...... B whnrn oven ied? � ... )' p .... ........`.-�-�--.�... .................... Is it painted c•>utsidt�-.... l Inside ?.... ...... Is the first story pia ered'!i: Sr:,�. Second story ':'L �... Are the chimneys all cif brick ?................ Are they in goon condition?r.f.uY.. .... lfo%v high above the roof is the lowest?.................feet. 'Phe pipe nro in gr,,►cf t ondition, safely secured and/enter the chimney horiznntally by a thimble or are firinly cemented therein. ;kil wood - mh, s r.r•e kept at leapt thirty feet from any insurerl bUilc_ling or in .................. ................................ ..... Value Material How Old? Cover I►,cx►f Corrdit:ion Painted SIZE OF Bt71LDIN6,14, Height l I, of Post". ....... .............. ..... > I� BarnNo. 1.. ...... ................. .............. .......... ................ ........ xy........ x ...................... ../..... x ......tarn No. 2.. .............. ......... ......... .......(J5/.x 2I.. / ... BarnNo. ................ ................ ................. .................. ......... ......................... ............... i......... ........ ..... . X .a..... .. x Loss, if any on buildings, payable to .......... �...,,n..�.......4..t-- :......�._.......... ..... ... . . ................................. Mortgagee...... , a4 ......• interest...... may appear. What buildings, if any, are equipped. with lightning rods?...... ............................. ................... Name of rnanufactnrer? ............................................................. Date installed ? ......................... Are all grotind connections sa*l,is factorv........... � Total insurance on rodded buildings $............... : 25 per cent discount for sodded buildings $.............. Hns the Applicant ever !;<rd a. fire? ............... If so, give origin and explanation...... ..................................... Has tho. applicant any special reason to fF,,ir fire fl-wn incendiarism?............... Is there any other Insurance on this property, or ally other exposed with it, in this Conipany ?............ If so, state ainount $.............. Fame of Insured........................................ No. of Poliev...,..... ........ Is there any other Insurance in any other Company . If so, state amount and what it covers, on }sac] What is your title or interest in the property? .... .........L7.� 'a P 1 Y ... ... c............. How much r., it encumberE.d ....... .................... .................... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind wN-self and my heirs, executers, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga. Comity, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Li:ghtninZ, sustained by >tny member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Associatior) iS orIjarrized and in conformity wit -Ili the By -Laws of the Association. ............. ...... .,......................................... Applicant. The kolicitor will please answer the following Questions :— Have you carefully examined the above risk? .......... I... When did you inspect the rick inside and outside? .�.` Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chi, ineys?.................. Are they apparently safe?.... ... Do you know of any facts creating it oral hazard .... ....... 1r ... ..... .solicitor. THE FARMERS' MUTUAL INDEMNITYASSOCIATION o P 0 of Cayuga County 0 0 lRo. APPLICATION pF �......�.t .. ....1... L.-...' :....... ........ R. D... P County of..:,,. .. ...am 0 f State of �? P" �- .. Town of......�..................... V ^ . Pre rniuni ............ ..... ........... ; Discount for approved Lightning Rods .... .............. ................ . Total ........ ......................... 0 0 P Date ARiBk �.Y.1....'�.. ...........��)��. Time—, .........years. P P 0 SOLICITOR. 0 Renewal of Policy No...-.,_..�. G ...1!... ...... 0 _. Reinsured `... Material of house No. :3............ ............... Age ............ A,ears. In what repair?................................ Is it necessary and c 0 remunerative in its present condition ?............... Is it painted ?............... Is it plastered ?............... Are .the stove@, v a pipes and chimneys in good condition and apparent-ly safe ?......... Where and how are ashes kept? .................. a ........................................ ... ............................ SOLICITOR. .n EAST • c bi ►... ~ ' f f �' A 4- �. u. : L 4 to Ce c jX'11 M ....... It. F. D. N7() ............ pt)stotfiee ...... Z ......................... ippItcatton ...... ..... ................ ........ County oL. ..... and State of New York for insurance against loss or damage by fire or lightning in TH FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the term of from day ............. 92.,t; at, noon, to ......192.. at, noon, on property located on the..,...;..' .....side of ........ I . . . . . ... . . yl, from..... A the Town of .............. . ................ ..................... and State of New York, as follows 1 1. f - L�t ............ 0juntv Amount Amomit Insured Insured ..................On Dwelling House and Attachments .................On Corn ilarn or Granary ................On Household Furniture, Printed Books., Produce im Premises Pictures, Silver and Plate, Provisions and Wearing Apparel on preinises, ................. On Farming Utensils, Carriages, Swieigh,�4, P3 $ .............. .On Piano Robes, Harness and Automobiles $ .................On Organ $ ..... ............ Oil Horses $................. On Phonograph and Records $ ..................On cattle "t, $ . .............On Registered Cattle Barn No. I $ .................. 0 n Sheep $ .................On Barn No. 2 $ .................. On Fowls .................. On Barn No. .3 $ .................On Swi ne ....... ......... Oil Barn No. 4 $ .................On..,,. ..... ........ ..................On Hoo, House 0 $....... .........Oil ... .................. ..... ........................... 1 . ................. On Heil House C" ) ..Total ............Rate ........... Premium How nianv acres of land in this place?............ What is the value of the land and buildings? $ ... ........ How many stories I in dtit c-Iling house? .............. By whom occupied? ....................... ........ ................ Dq it painted outside ................ ............... -ick Inside ? ...... ........ Is the first story plastered ? ......... ..... Second story Are the chimneys all of brick................. ........ Are they in good condition? ..................... How high above the roof is the lowest?..................feet. The pipes are in good ('"Ildition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .................................... ........... ........... Value Alaterial flow Old? Cover Roof Condition Painted SIZE OF 13WILT)INGS i Height of Posts $ ............... ...... .......... ...... ........... .................. ...... i ........... ...................... ........ x ........ a ......... x ..... ....... ..... IlarnNo. L. ................ .................. ........... . .... ................. ..) . I_ , __ -, '. / & ....... ...... -a ......... x BarnNo. 2.. .................. .................. .................. .................. ....................... x ............ BarnNo. 3".. ................................ .................. .................. ........ .......... ........ ......... x ......... a ......... x ...... ............. ......... ........ $................. ............ I .. ................. ......... ........ ......... ........ ........... ......... ......... x ........ X ..... .............. Loss. if any on buildings, payable to............ ..................... .... ..................................... ................... ................................. ................................. Mortgagee...... , as................ interest...... may appear. What buildings, if any, are equipped with lightning rods? ............ ............. ..... ,Name of man n fact ki rer? ............................................................... Date installed ............................ Are all ground connections satisfactory ? ...... 11 1 Total insurance on rodded buildings :25 percent discount for rodded bilildirlyq , $../ ... I ...... Has tLe Applicant ever give origin and explanation............................................. had a fire? ............... If Sol Z, g...................................... Has the Applicant any special reason to fear tire from incendiarisin ? ............... Is there any other Insurance on this property, or any other expoQed with it, in tbi,4, Company ? ............ If so, state amount $.............. Name of Insured ......................................... No. of polieN ................... Is there nny other Insurance in any other Company If so, state amount and what it covers, oil back. What, is volir title or interest in the property ? ......................................... How nitien is it encumbered ? ............................ ............... ..... In Coiisidei-ation, of the Insurance obtained on property named, I do hereby give my Undertaking, whi-reby I bird myself and nlv twirl, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any mernber thereof, during my membership. Given in pursuance of Section 7 of the Act under whieh tbe Association is organized and in conformity with the By -Laws of the Association. ............. I ............................. .............. I ..... Applicant. The. Solicitor will please answer the following Questions Have you carefully examined the above risk? .............. 11'hen did you inspect the risk inside' and outside?... Did you then inspect, the chimneys and pipes where they pass through partitions and floors and enter chimileys? .................. Are they apparently safe? ............ ..... Do you know of any facts creating moral ........ ...... ........ .... Solieltor. THEFARMERS' MUTUAL f � INDEMNITY ASSOCIATION � of Cayuga County lRo. APPLICATION OF ........................... ....:.1..... a-. A-:-.. �::.... R. D................... � County of.:-.. J . State of ......... �. }_ ...�....�. ..................... Town of....... �+ ...� a :.�. �- ..�L.�........... t r P re m iunn ............ ................ ..!-. ........... Discomfit fs))' approveki �JQ Lightning Rods.... ............. i ........... _.. . Total................................... :i;./..G`.. `..o.. '0 I)• +�f tisi' ,.�- G.1....... �. ...........'� ate f� �.. Tln]....... ......y'PRra. SOLICITOR. Renewal of Policy No.. 1..... . � heinsi)red N'o....... '-. ;r. : Material of house No. 2............ ............... Age...... .,....� ears. ' In what repair ? ................................ Is it necessary and c rern))nerati��e in its present condition ?............... Is it painted ?.....•.••.••••. Is it plastered ?............... Are the stores a nd chimneys in good condition and apparently safe ?.................... pipes aWhere and how are ashes kept.? ....•..••••. •••••• ........................................ ... ...........................SOLICITOR. .� .AST C •bi • T W Jl 0-4 �: A �C ad,. cc tW Ce r c ► (_ :. r IICatI011 (7t....v..��u..L ., . �- cc .?- ....... �. .� .. Wit: It. F. n. ;►............ 1,4),40►ttice..... .... 1. LI.: �. :.? .......... pp�. .,�..�.. Connty of.................................and St"cte of New York, for insurance against It►ss t►r damage by fire or light,txing ill THE FARMERS' 81UTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of ....... I..... ..vent-s from day dayof.. ,.�..�............'192.�11 al noon, to d a v r,f.t :.z`.. .......1t12...% at noon, nn property located on th+a.... �.... .:.... �.�.. :� s P roN% ..1.Q. side of.. .road, rr�ilcti.in the n of �......... County ►,f:.,..`:...:. t.......c..:... ....a.. ......and State of New York, as follows A mount Insured `..::..:..�..... On Dwelling House and Attachments .................On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises ............... .On Piano $ .................On Organ $................. On Phonograph and Records .4..i.>...On.: L' �...... �.'..... .. t......:��. l� ..................On Earn No. 1 ..� ....On Barn No. 2 ..................On Barn No. 3 ....... .........On Barn No. 4 ..................On Hog House .................On Hen House A wc►u lit Insured $ ..................On Corn Barn or Granary Produce mi Premises ................. On Farming Utensils, Carriages, �clYlgl��, Robes, Harness and Automohiley $ .................On Horse, $ ..................On Cattle $ ..............On Registc-red Cattle $.................. Oil Sheep $ ..................On Fowls $ .................On wine ................Oil................................:....................... $....... .........On on. ..................... ..... .. I........................ ............Rate ......... premium How itiany acres of land in this place?............ What is the value of the land and buildings? $........... How Inativ sto ries in dwelling house?............... By whom occupied?....�........::...... ....:......... .................... Is it painted Inside.? ...... .... Is the first story Second story? ................. Are the chimneys all of brick ?......�;` ........ Are they in good condition? ........:...:..'...... How high above the roof is the lowest? ......... ::......... feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .......................................................... Value Material How Old? Corer Roof Condition Painted SIZE OF BUILDINGS I Height {{ ( ()f Posts IIt►llse ....... .,�.....�.....:. .......... ...... ........... .:.... .TJJl...... . '.:,.....L...... .... ..r..:. ................ x......... a ........ Ix ..... ' { BarnNo. 1.. $...... ................. ........................ ................. ........ ........ ... .........x.........a.........x .............. BarnNo. 2.. .......... - '�.......:`:.......'.:................. .....✓........... l.....:. �............................. ' .. ...... i ....... ... I BarnNo. 3.. $ ................ ................. .................. .................. .................. .............................. x.........a......... 'C...... i ......... ........i................. ............... ........-........ .................. .................... ......... x ........a..... . x ..... �.............. Loss, if any on buildings, payable to................................................................................................. ....................... .................................Mortgagee......, as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods?.... .4: �.. .....'.!: ::�.:z: '......— i-L- �'1.�.... Name of manufacturer' ............................................................. , '. .......................... Are all ground connections satisfactory .... ...... Date installed � 1 � Total insurance on rodded buildings �......:`...;... �; 25 per cent discount for rodded buildings .;` ...::.. I -lag tLe Applicant ever had a fire?.......If so, give ori-in and explanation ........... ............................... Has the Applicant anv special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or 2,111v other exposed with it, in this Company?............ If so, state amount $.............. Name of Insured ...... .............. I ... .................. No. of Poli ........ ........ Is there any other Insurance in any other Company ?...:.::.' If so, state amount and what it, covers, on back. What is vonr title or interest in the property ? ......................................... How much is it encumbered ?.......................... ..................... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby [ bind myself and my lif-irs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cavuga County, N. Y., my pro rats share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ............. ...... ......................... .................... Applicant. The Solicit+-r will please answer the following Questions :— Have you carefully examined the above risk? .... When did you inspect the risk inside and outside'? .... ...... /.......� Did you then inspect the chinrnevr and pipes where they pass through partitions and floors and enter chininevs?.................. Are they apparently Do you know of any facts creating moral hazard? .......`...t:' ..................... �, �.......�. , `.. :r �... �:.....�olie itor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION � of CCounty 1Fto. APPLICATION-�--O�-�F• .....� . .. t- .. _-� . .. R. D..... .............. County of. ...... State of ......... k:. f..�..: �`- ..l' ..... Town of....... ` ` ......... P�nliun�..... -----. c...L .: �...� ... cy Discount for approved Lightning Rods.... .... ................ 0 Total................................. ................... Date of ... ........... 192..� SOLICITOR. '.:�.l.t%..?C.(,.'. � Renewal of Policy No....:. Reinsured No......... ...... s �o► �vrr�1► ��►'' !'4 �►r4 -%V1W W % Material of house No.:.. ...........IN ...... Age............ ears. In what repair ? ................................ Is it necessary and o • ...... Is it painted? Is it plastered ?............... Are the stoves, ' remunerative in its present condition ?......... ••••••••••••••' ' . - a pipes and chimneys in good condition and apparently safe ?......... ........... Where and how are ashes kept? ........................ ...............................:.. ... ............................SOLICITOR. 3 EAST o. Uo Cie GOD. GOD. GC a; Y rl. Wi r. 3 bc CI Cd O • Y it; if.,, ApplICat1011 of......... '.......1..........:......................... R. F. 1).. N+,............ 1'+,stoftice....... J '��...,..�:...<:, .....'.. Collrrty of...:... State of New York, for insurance against lass +►r damage by fire +►r lightrrin in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of .... ..........Fears, from ihc�..�-..{�.. day of.......:..!... ........lc)`'� ttt: noolil t,+► tile .......:.�.daV ctf...... t,. f....lc)� at noon, on property lo;�tted «rt t1►c�......... .....s►dc:� of..................road, : _....miles froill...... ::.......... tl►e. Town of .......................... ....County of............:�..t:..::.. �..t:: : ...and State of 'c�w York, as foll�iw5 . Amount A rnou nt Insured Insured .........'...:?....On Dwelling House and Attachments .. ..............On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises .............. On Piano $ .................On Organ $................. On Phonograph and Records $.................. On .... ................................... .l.:.. ..........On Barn No. 1 $ .................On Barn No. 2 r $ ..................On Barn No. 3 ................On Barn No. 4 $ ..................On Corn I -tarn or Granary .,::............On Produce on Prern►sFs : t e`i / G..AV �.- ........rr ... OFarming Utensils, Carriages, Sleighs, Rol_,es, Harness and Antorytobiles $.................. On Horses $ ..................On Cattle $ ..............On Regi4tered 01,ttle $..................O11 Sheep $ ..................On Fowls $ .................On Swi tie ................. ()n........................ ....................... .......... A...................On Hog House $....... .........()ri ...................... ............................... .................On Hen House $..:..�:.� .:..:..Total ............Rate ......... premium H+►w wany acres of land in this place?............ What is the vahie of the land and buildings? $........... How many stories in dwelling house? .............. By whoreocettpied?....................... .............. .................. Is it painted outside?............... Inside ?.............. Is the first story plastered ?......... ..... Second story'? ............... Are the chimneys all of brick? ........ ........ Are they in good condition? ..................... How high above the roof is the lowest? .................. feet. The pipes are in good rendition, safely secured and enter the chin►ney horizontally by a thimble or are firmly cemented therein. All wood ashes are kelrt at least thirty feet from any insured building or in ............................................... I.......... Value Material How Old? Cover Roof Condition Painted i SIZE OF BUILDINGS Heigrht of Posts house........' ............... ..... ............................................................. .................... ........ x........ a ......... x...... , tarn No. 1.. $. ................. ......... ... .........x.........a.........x i ............ 1 ..... ......... ... ............. 1',arn No. 2.. $................................ .................. .................. .................. '...................... ! .........x ........ a........ x...... ....... BarnNo. $...................................................................................... ..................... ' .........x......... a......... x .............................................. .......................... ........ .................. ..................... .........x ........a..... ..x ..... ;............. Loss. it any on buildings, payable to.......................................:.................................I.. I ............................................. ..... ................................. Mortgagee...... , as................ Interest...... may appear. What btrildipgs, if any, are equipped with lightning rods?................................................................. Name of n►antrfaeWrer*' .....................................I....................... Date installed .......................... r.. all ground connections satisfactory ............. Malld? Are 'Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $.............. Has tLe Applicant ever ... If so, give origin and explanation....... ..................................... Has the Applicant any spocial reason to fear fire from ineendiarisrn ?............... Is there any other Insurance on this property, or any other expose(l with it, in this Con ► pan y?............ If so, state arr:ount $.............. Nanie of Insured ......................................... No. of Poliev......... ........ Is there any other Insurance in any other Company? ......... If so, state amount and what it cover's, on back. What. is your t it'10 or i<rtterest in the property ? ......................................... How much is it encumbered? ............................................... In Consideratiort of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind ziNvst?if and ray heirs, exectibm-s, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., n y pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any rrternber thereof, daring my membership. Given in pursuance of Section i of the Act under which the Association is +_►rl-ran.ized and in conformity with the Iffy -Laws of the Association. ............ ......................................I........ Applieant. The. Solicitor will please answer the fol!lowitirrg Questions :— Have you carefully examined the above risk? .............. When did you inspect the risk ineide and outside?. ............. Did you then inspect, the chin►neys and pipes where they pass through partitions and floors and enter chinrr►r vs ?.................. Are they apparently safe?......... ..... Do you know of any facts creating moral hazard? ... P ...,..........�. ..................olicttor., FARMERS' MUTUAL p INDEMNITY ASSOCIATION of Cayuga Countyll 0. ---7 --------------- - ,.�� APPLTC,X TON OF ..........•.r:.. ..:..:. :..�........R.. D......../ ....... Count of .............. d.... ........`� State of..............X.. A ........................... Townof ......................... ..................... Premium............................. $........... ...... Survey Fee.......................... $................. Total..... ..................... ........�.. - %ate --- -,�-__ -_� - Date of Risk-....�'..�::.... ... z,,.� . .......191.,, 7 Time....:: ....... ... 1,. years. SOLICITOR. Renewal of Policy No .............. .. , ........... , Reinsured No...,:... ..d�:...�................ Material of house No. 2...................... • ........ Age ............... years. In what repair ?................... Is it necessary and � remunerative in its present condition ?.................... Is it painted ?....................... Is it plastered? Are the stoves, pipes L and chimneys in good condition and apparently safe ?.......................... Where and how are ashes kept ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •.... U ............................................................................ SOLICITOR. 3 c c East o • •C b ti4 ^ Z Pal � L-L � � W O o � TW . � o U "C .a • • c c c � � � c Ghi- 4 Ir It. F. D. N ............. Postoffice . ......... ..... ........... .. ................. ZiPpItcatton of . ................... ...... ......... County of .................................................and St4te of New York, for insurance against loss or damage by fire or lightning in the FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. 7 y ..... 1917.at noon, -to the..'�-,�J ..... day of .... e. for the term ......... ear-, from the..,_ ......day of.... ate of New York, a at noon, on property located in the town of .............. ................... ..'Coti tit N, of Cayuga and St, ]lows: Amount V,,ihie of I Height i SIZE OF BU111,I)INGS Insured Buildings of Posts On D"ellii)g HOLISe and Attachments ............................. .... $ ............. $ .............. ............... ..... ...... x ........... a ........... x ............ On Household Furniture, Provisions and Weariiio, Apptarel and on premises ..................... .................... . therein ....... ............ Oil Piano, $ ......... Organ, _Nlelodeon, $ ......... t 1) ere i n ... On Printed Books, Pictures, 'Silver and Plate therein........ ........... On............................................. ................... ............... ............... ............... ............... OnBarn No. I ............................................................... ..................... I ........ ..... ....... ............ x .............. I ............ X ............ OnBarn No. 2 ........................ ........................................ ......... I ..... ..... ..... ........ ...... ........... X .............. I ............ X ............ OnBarn No. 3 ........................................... ..... .............. ............... ....... ....... ............. ..... .... . x ............ a ............ x .......... On Barn No. 4 ............ ................ .... ............................. ........ ......... ... ..... ........... ............ X ............ . 11 ..... ...... x ....... OnCorn Barn or Granary ......................................... ...... ....... ...... ............... ..... .. ...... .......... . x ............ a ............ x ............ On Produce in said Barns and on Premises ......................... IJ ....... I PRESENT NO. OF ANIMALS Cattle...:::: . ,: ...... Oil ........................... . ......................... ...... ...... . .. ....... orses ...... ...... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep...�� .............. Fowls ............... in said buildings and on Premises ............................ ......... INDIVIDUAL LIMIT ON On Live Stock, On Horses, ......... On Citfle ..... Horses $ ...............Cattle $ .. ................... Sheep $ .............. to -wit On Sheep, Oil Fowls, $ ........ I ......... Fowls Rate......... .............. ............................. Total, Premium ................................ Situated in the town of ................................Cayuga County, N. Y. flow many acres of land in this place ? ............ W hat is the value of the land and buildings ? $ ................. Of what material is the house ? ....... .............. How old is it? ............ years. How many stories ? ............ For what is it, occupied ? ................. By whom ? ........... ............... Is it painted outside ? ........... Inside ? ............... In what repair ? .................. Is the first story, plastered ? ............... Second story ? ............ Are the chimneys all of brick ? ......... Are they in good condition ? .... How high above the roof is the lowest ? ........ feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in ................................................. Barns —Material. How Old ? Cover of Roof. Condition. How Finished ? Painted. No. 1 ................... .......................... I ................ ......... ...................... I . ..... I ......... ....................... 11 1*111*1 1 ******** ...... No. 2 ................... .......................... i ....... ................... .................. ...... ......... ....... ......................... .... **1* ...... I No. 3 ............................................ 1! .................. ........ .............. ........... ............................................ ..... i ... . ....... ........ ........................... .. ............. ....... . ....... ................. .......................... ................................. .............. ........ ........ ......... Loss, if any on buildings, Payable to ..................... .................... .................................................................................. ............... ....... ........ ............................................... ...... ................. as ........... ...... ............ interest ............ may �nnear. Has the Applicant ever had a fii-e? .............. If so, give origin and explanation....................................... Has the Applicant any special reason to fear fire front incendiarisin ? ............ Is there any otlier Insurance on this property, or any other exposed with it, in this Company ? ............ If so, state amount $ ............ Name of Insured ............................................ of Policy.................. Is there any Insurance in any other Company ? ............ If so, state amount and what it covers, oil back. Wliat is your title or interest in the property ? ............. ............................................ How much is it encumbered ? $ ... ............ ... .................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, w1wreby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or 1,ightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under wf)icli the Associat,ion is organ - zed and in conformity with the By -Laws of the Association. ..................................... ........................................................ ..... . "..............Applicant. The Solicitor will please answer the following Qilestions:— Have you carefully examined the above risk ? ............ When did you last examine it, ? ........ ......... .............. Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter cli-imneys?........... .......... kre they apparently safe ? .................. Do you know of any acts creating moral hazard ? ............ Date of Inspection ............................................. 191.. ........... ........ ..... ....... Solicitor. Material of house No. 2................................ Age ............... years. In what repair ?........ ............. Is it necessary and p remunerative in its present condition ?.................... Is it painted ?....................... Is it plastered? Are the stoves, pipes FARMERS' MUTUAL and chimneys in good condition and apparently safe ?.......................... Where and how are ashes kept ?.................................. U NDEMNITY A IATI .................................................. SOLICITOR. ssoc oN3 East of Cayuga Countyl . bo TRo.-I_ _ . P APP ICATION OF ..........-:.................. . ........ ........................R. D............... .. �Q County of ..... Z:2 ......... :: . ..... - ........ z �' z c o State of....... ��.��.�....... ....... ................ a� y s Townof ......................... ~................. / `� � ------------•- y. (-� ram' � � I-1 � s. er m C Premium ........ s Survev Fee .......................... $....... s......... A Total................................. ... Date of Risk..-... %. a . ... Time......... ..........years. o � c Cd ..� . SOLICITOR. on Renewal of Policy No ' Reinsured No ........................................... c 44 A4 A; °° zwPitcatton ot.70. R. F. D. No ............. Posto�tlice.. .... G'�.., Comity of .. �... ................. vv.,r�..and State of New York, for insurance against loss <-r damage by fire or lightning in the AR HERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of...... ... years from the.....:;: l...dav Of...? <�r �........ 1J1 �-at nc,on, to the .... z.7..da.y ()f.... A4........ at noon, on property located in the town of....... ...................... ...... Cotrrit`T of Cayuga and Slate of New York, as follows: ArrrOunt I Value of Height i - Inslli't'd Buildings of Posts SIZL OF BUILDINGS On D%%elling House and Attachnients............................. ... I$ .............. ............................. ........ x .......... a ...........x ............ f Oil Household Furniturt�, Provisions and NVearing Apparel therein and on premises .................................................... Oil Piano, $L—A Organ, ....... Melodeon, $......... therein .... . On Printed Books, Pictures, Silvt-r aid Plata therein....... ............... OIl............................................. .................. ........ ...... ............... ...............I.............. � I OnBarn No. l.................................. OnBarn No. `?........................... ............................ ....... ..... ........... x ............. I............ x ............ On Barn No. 3 ............................................. ....... ............. , ..... .... .x ............ a............ x.......... On Barn No. 4............ ................................................ ............I............ x ............ .1........... x ............ OnCorn Barn or Granary......................................................................................... On� roduce in said Barns and oil Premises d.... ............................Z. i 1'i:L;SF,N'' NO. OF �1NIIIALS On............................................ .......................... ........................................ I'� H orses............... Cat.tle............... On Farin Utensils, Carriages, Sleighs, Robes and Ilarnesses "Sheep ................. Fowls............... in said buildings and on Premises ............................ I „J�, d INDIVIDUAL LIMIT ON 1 On Live Stock, On Horses i .� 'S � °:?� .On Cat iet,, � .....'.... Ii Horses ...............Cattle $............. to -wit . On4Sheep, $..... , . On Fowls ........ ! ........... .. ... `}seep ....... ......... h'o«-1s �......... .. Rate.........�.................................... Total �- ... f i . � � � ............. Premium .�........... Situated in the town (�t.... ........:::?!�!........ a � T ...Caj-u�,a (,ounty, N. Y. How many acres ? .. ... ...... What is the of land in this place .............. value of the land and buildings'? ................. Of what material is the house ?....... ............ How old is it ? ............years. flow many stories '?............ For what is it occupied ?................. By whom ........................... Is it painted outside ?........... Inside ?............... In what repair ?.................. Is the first story plastered ?............... Second story ?............Are the chimneys all of brick ?......... Are they in g(-,od condition ?....> .. How high above the roof is the lowest ?........ feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thin►ble or are firmly cemented therein. All wood ashes are kept at least thirty feet, from any insured building or in ................................................ Barns-1'Iaterlal. How Old ? Cover of Roof. Condition. How Finished ? Painted. No. I ................... ....... ........................ ....................... .............. ................. ...... ........ I........................... No. 2........................ .................... ....................... i...... ................ No. 3............................................ ........................ .......... ........... ......................................... ... .. ....... ....... ................................................ ...... ................. .......................................................... ............. ........................ Loss, if any on buildings, Payable to.......................................................................................................................... .....................�.............-....=t_as"...'..'_.._.............�r..;_......='.as................. ............ Interest ......y.....may appear. Ibis the Applicant ever had a fire ? .............. If tio, give origin and expl,ination....................................... ,l Has a, the Applicant any special reason to fear fire froin incendiarisin ?............ Is there any other Insurance on this property, or any other exposed with it, in this Company ?............ If s�). state ainount gip............ Name of Insured .............. ...........................No. of Policy ......... Is there any Insurance in <-iny ()thor Company ?............ If so, state amount and what it covers, on back. NVIrat is your title or interest in the property '?........................................................... How much is it encumbered :' $.................................... In Consideration of the Insurance obtained oil property named, I do hereby give my Undertakinf;, w 1wrc•by I hind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL P1jDEM,ilTY ScC)CIATIGN, of Cayuga County, N. Y., my pru rata shar:, of all liabilities incurred by the Association, and all lossei by Fire or �T,i�'i�rtiis! , sustained by any inember•thereof, during isle membership. Liven in pursuance of Section 7 of the Act rincles• wiiir-h tht, is organ - zed and in conformity with the By -Laws of the ASsoM on. ..... ` ..... ......... .... ,-d►�..... .. . ..... A plicant. The Solicitor will please answer the following Qi_iestions:— Have you carefully examined the above risk ?............ When did you last examine it. ?................. ..............Did yt)u then inspect, the chimneys and pipes where they pass through partitions and floors and enter chimneys ? ...................Are they apparently safe ? .................. Do you know of any acts creating moral hazard ?............ Dateof Inspection .............................................. 1 (1) L......................... C'J J(..�.%............................. Solicitor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of 'Cayuga County 1R0. _ 4�AP LIC ION OF ... H ... ..... R. D. .......... 0 Countyof..... .................... ................ State of ..... /• .............. _ Town of.�,..��. ........ ..... PI em iui11............ Discount for apprm-ed Lightning Rods..... ............. .......... . Tonal....................................�..�`.. Pate of Risk-' 1p? Time........ ........ ...... years. ..................... SOLICITOR. RODewal of P(,licy No........ , .... Reinsured Nip ....... .......;..,..::.�....... ...... Material of house No. 2............ ................ Age............ years. In what repair? ........... ............... Is it necessary and re►ntinerative in its present condition ?........... .... Is it painted ?............... Is it plastered ?:.............. Are _the stoves, pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept ?........................ ........................................ ... ............................ SOLICITOR. E A ST IF2 H A F_ WEST c� 0 0 m c. a� a 3 J � .. b ipplICat'IOIi ...... ,........ � ................... R. F. D. tir►..�. �.... Postr►illcc�.. f! �; �.�: 0-►tinty of-T........... ...................inMa te ate of New Yorkam , for insurance against loss or damage by fire or lightning in C TH FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of .�y.... ...year= from the... .... day c .�:� �... i92!Zat, 110011 , to the.... -...dray o .....1�)'� at noon, on property located on the..............side of..................road I .........miles fr.orn.............................. .....iri the Town of ............C(,untti' ......and State of New York, as follows .- A mount Insured ............On Dwelling House and Attachments ...• �.. b.On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises .............. On Piano $ .... ��j..... O..On Organ $................. On Phonograph and Records $.................. Oil.... ................................... $ ..................On Barn No. 1 $ .................On Barn No. $ ..................On Barn No. 3 ....... .........On Barn No. -f ' ..................On Hog House .................On Hen House Amount Insured $ .................Oil Corn 11arn or (granary $� ..0.. Oil Prodire on Premises v... On Farming Utensils, Carriages, Sleigll:-4, Robes, [largess and Autornohiles °�...1. ..�....On Horses $.. ..D... b...On Catt le .........On Registered Cattle $ ..................Oil Sheep $........ 7..� ...On Fowls $ .................On Swi rAo $.................()11.................. ........................... .......... $....... .........Oil .................................................._... �1.. .`:..Total ............Rate .......... Premium flow many acres of land in this place?............ What is the value of the lend and building?? $... ........ How gram• :stories in dwelling house? .............. By whom occupied?....................... .............I .................... Is it painted outside-?.............. Inside ?.............. Is the first story plastered'?.............. Second story ?............... Are the chimneys all of brick? ........ ........ Are they in good condition? ................... .. How high above the roof is the lowest? ..................feet. The pipe,4 are in good ec)ndition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any Insured building or in ....................................................... Value Material How Old? Cover Roof Condition Painted SIZE OF Bt7I.LDINGS Height of Posts House........ $............... ............................................................. .x.........a.........x...... ............ BarnNo. I_ $................................................ ................. ........ ....... ..................... ......... x........ ,a......... x Barn No. 2.. $.......................................................................................................... ....... ........ .........x .a........ Barr► No. 3.. $...................................................................................... ..................... ..................$................................ .........................................................0.............. .......... x ........ a..... .. s ..... ............ Loss, if any on buildings, payable to.............................................................................................................................. ................................ Mortgagee....... as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods?........ ................................................... Name of tnamifaetnrer'' .............................................................. Date installed ............................ Are all ground connections satisfa ory ............. � ct ? Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $.............. Has the Applicant ever had a fire ?............... If so, give origin and explanation ..................... Has the .Anplira►it any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or ai)y other exposed with it, in this Con► any ?............ If so, state aniount $.............. Na►ne of Insured........................... T P' `o. of Policy ........ ........ Is there any other Insurance in any other Company ?......... If so, state amount and what it covers, on hack. What is voir title or interest in the property ? ........................................ How much is it encumbered ?........................... In Consideration of the Insurance obtained on property named, I do hereby give my Undertakin6, whereby I I)uid my -elf and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayiga County, N.I. Y., my pro rats share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by anv member thereof, during my rnembership. Given in pursuance of Section i of the Net under which the :Association iy organized and in conformity with the By -Laws of the Association. ............. ............. ....... I ...... ........... .......... Applicant. The. Solicitor will please answer the following Questions :— Have you carefully examined the above risk?.............. When did you inspect the risk inside and outside? .......................... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently Fafe?.................. Igo you know of any facts creating moral hazard?................. ................................................ ...........Solicitor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County APPLICATIO OF 3 � �j1 .. (..... .. ... .... ...... . � .....C,:./.jZ.Q'.. r ............R. D.�... County of..,. i� Stateof........... .... ...... ........ Town of .....�%.�.r ... ......... Premium ............................. I ... .. Discount for approved Lightning Rods ..................... $....... ........ Total............................ ......�'.a.. G Date of Risk ..... .... .......... j .........19214' Time.......... ............. years. • ., ................... SOLICITOR. Y Renewal of Policy No.... t Reinsured Igo. ........ r:...........ItAe.......... . Material of house No. 2...... .......................... Age ...........years. In what repair? ........ ........................ Is it necessary and remunerative in its present condition ? ........:........I Is it painted? ................. Is it plastered? ................ Are the stoves, pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept ?........................... U Q z W 0 O x U CIO H A ....................................................................... SOLICITOR. EAST WEST Io t ot. [�cati �.1.... ` l�. F. D. No...�.1. Postoflice...... �r?...� .Cam......... U �id State of New York, for insurance against loss or damage by fire or lightning in Coun t v of . ��'�,tt ...... . TH FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of— ...........years from the.. ...(,. dad• of ......192.4 at noon, to t le.�. ...day of .L .` •.ltl'�.� at noc►n, on property located on the. side of .................rc►,�d, ,�....rniles from. .K:........ i the '1'o��n of n'��..L..�............County of. Z��r't,wt.�j:. ........and ;tale t►f New York, as follows . i A mount Amount Insured Insured ..(7.P—!. ....On Dwelling House and Attachrnelrts .................On Corn Barn or Granary f � ..�..C).... On Household Furniture, Printed Kooks, ......... ..... ,On Produce on Premises Pictures, Silver and Plate, Provislot;•? -- � T � , and Wearing Apparel on preu►ises �`�••`•••�••••�•• On Farming Utensils, Carriages, �leigtis, b pl Robes, Harness and automobile` $............... On Piano '`� �. .. ..On Horses 8 ................On Organ c �-A �..d...On Cattle;..........On Phonograph and Records .............On Registered Car le .... ...On .... .................. .n............................. .On Sheep ch........ .........O1r B€ir•n No. 2 . ..... .........On Swine .................On Barn No. 3 ....... ......L....On Barn No. 4 ....ax..7/ ........On . ................. ..... ........ ............ ..... On Hog Hi use / ! L.-- I f J c3 ...y ..Total .... �f•...nate Prer�tit�m ... „�...On Hen 1-1i ►rise... How many acres of land in this p11ace?.&:1.../,- \Vl1at is the value of the land and buildings? $... ........ How ►nany stories ? r�� B �� horn oceu is d '�..O in dwelling hou�e ..�.. .�..... y p � :..i�..,(W�l ........................... Is it painted outside ...%7.ff....... Inside ?.. ..... Is the first story plaatered `!... second story ?., ZQ':.... Are the chimneys all of brick ?. ....... Are they in good condition?.... . ....... How high al)ove the roof is the lowest ?...L�..........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashe- are kept at least thirty feet from any insured building or in .................. ...................................... Value Material How Old? ! Cover Hoof Condition 1 Painted SIZE OF BUILDING'S Height i of Pest House........ $............... ..... ............................................................ ......... ....x.........a.........x...... ..... BarnNo. 1.. $...................................... .......... ................ ........ .........x........a.........x ..... • ............. BarnNo. 2.. $................................................ ............ ...,... ..................... .....x ........ a ......... x...... ............ BarnNo. 3.. $ ................ .................. x....... .........a. .x...... i .................. $................. ............... ......... ........ ......... ....... ! .......... ......... ...... x ........ a..... . x ...... ..... Loss. if any on buildings, payable to ................. fl-'...... � `' �.:�'`�'.................... ............. ..... r ................................. Mortgagee..... , as,.O�... Interest ..... may appear. What buildir�gc, if ,�r�v, are equipped with lightning rods? ................................. ............................ Name of man rrfact rrrer' ....................................................... I...... Date installed.......................... r all ground connections satisfactory ............. '� Are � `� 'hotal insurance on rodded buildings $................ ` 5 per cent discount for rodded buildings $.............. Has the Applicant ever had a fire ?............... If so, give origin and explanation........................................... Has the applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this prop(,,rty, or any other exposed with it, in thi9 Company ?............ If so, state amount $.............. Name of Insured ....................................... No. of Poliev................. Is there any other Insurance in any other Compa y?......... If so, state amount and what it covers, on back. What is your title or interest in the property? .......�72.. .................. How mile is it encumbered? ... /,; . rr.. .......................... ..... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind rvivself and my heirs, executors, administrators and assiizns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Asw)ciation, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the associatioli. � pD IICRnt. ...... The Solicitor will please answer the Following Questions: — Have you carefully examined the above risk?........ .... When did you inspect the risk inside and outside? .......................... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? ?.................. Are they apparently safe ?.................. Do you know of any facts creati 1 oral hazard ?...... ........ THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of u Ca a County�g lRo. -a�-3 APPLICATIO OF/ � ................. R. D..... .............. Countyof..... ...................................... State of 1" Town of........... ..L��.1'1............ ..... Premium ............................. .................. Discount for approved Lightning Rods..... .............. $........ . Total.................................. $..��... U...�. Date of Risk ...........1A�.1 Time ............. 3 ...... years. loo ................ G................. ..... SOLICITOR. 0 0 Renewal of Policy No ........... .................. Reinsured No .............................. ...... Material of house No. 2............................. Age ............vears. In what repair ?.......... ......... Is it necessary and o remunerative in its present condition ?............... Is it painted ?............... ,. Is it plastered ?............... Are the stoves, a pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept? ........................ .0 ........................................ .. . ............................SOLICITOR. 3 EAST a W : 3 0 z ti a H m a • ao as d d 0 =' b G cc ro WEST �; ` 1 Bpplicatiol1 0 ... L. .�.. ......a. ��•.`...... �.�. _� . 1 F. h., No............ 1'�,stotlic, .�:... .......I ...................... County of ................................... rrcl Stat.o of New York, for insurance against hiss or damage by fire or lightning ill TH,E FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. for the tens of.....:l......... years from the.., .. day of .. �� . L: ..... !9 2,-3, at noon, h) t,hc ,........day ,` .....1`1'2.�y at. noon, on property loeafed on the... ...side of ...... �:.......... road. ......... miles fr,►m............................. ✓....in the TO N%n {►f of... �ll.y. �..: j; ��....... C r :•�::. �. �... ...ancl , tate of New York, as folloNc's A mr►unt An►our►t In"llfed Insured $ ..................On Dwelling House and Attachments .., �...Or1 Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises ............. On Piano .................On Organ ..............•.. On Phonograph and Ileeo rds F..................Oil............... ....... .................. $ ..................On BHrn No. 1 $:................. On Barn No. 3 $........ .........On Barn No. 3 ................On Barn No. 4 .. ................On Hog House .................On Hen House $ ..................On Corn Barr► or GlratiAry $................ .On Produce im Prernises ................. ()n Farming Utensils, Carriages, Sleigh:4, I-N )bes, harness and Automobiles $..... ............ t On IIorsP:4 $ ..................On Cattle $ . .............on Registered Cats(}► $ ..................On Sheep $t..................On Fow is $ .................Ora swille $................. ()n.................. ..... ................ ...... .......... $....... ......... oil ...................... .......................... ..... $ G: `-5.R. Jotal ............Rate ......... Premium How niahy acres of land in this place?............ What is t}1e value of the land and buildings? $........... How manv stm-ies in dn-vIlitig house? .............. By whmn occupied?....................... .............. .................... Is it painted outside ?............... Inside ?.............. Is the first storyplastered! Second story'' . I .............. Are the chirnne_vs all of brick ?........ ........ Are the in nod condition? •........ y g ... How high above the roof is thc, lowest?..................feat. The pip:�w are in good condition, safoly secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood aAhes are kept at lea.sat thirty feet from any insured building or in ....................................................... Value Material How (--)ld ? Cover Roof Condition Painted. I SIZE OF BI ILDINGS Height, Hnure ........ .............. ..... .......... of Posts IlArnNo. L. $...... ................. ......................... .......................... ...................................... x......... a.........s BarnNo. 2.. ................................................ ...... ........ ` $ .........x........ a........ A ...... i..... ........ 11a.r•r► No. 3.. $.............................................................................,............................. :......... x......... a ......... x...... .............$................................ ........................................................................ ......... x........ a..... .x.....;............. Lass. if any on buildings, payable to................................................................................................. .... ........................ ................................ Mortgagee...... , as................ interest...... may appear. What buildings, if any, are ed►iipped with lightning rods?................................................................. Name of manufacturer" ............................................................ Date installed ?........................... Are all ground connections satisfactory ............. Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $.............. Has the Applicant ever had a fire? ............... If so, give origin and explanation............................................. Has the Applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this property, or any other exposed with it, in this Company?............ If so, state amount $.............. Narne of Insured......................................... No. of Poliev-........ ........ Is there any other Insurance in any other Company? ......... If so, state amount and what, it covers, on hack. What is your title or interest in the property ? ......................................... How much is it encurnbered ?............................ ..................... In Consideration of the Insurance obtained on property narned, I do hereby give my Undertaking, ",hereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, 14. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by anv member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ................... ...................... ...................... Applicant. The Solicitor will please answer the following Questions Have you carefully examined the above- risk? ............. When did you inspect the risk inside and outside''.......................... Did you them inspect the, chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently safe? .................. Do you know of any facts creating moral hazard? ........... ...... .......................................................... Solicitor, THE FARMERS'MUTUAL INDEMNITY ASSOCIATION of Cayuga Rio. , P-k -APPLICATION OFe . A. .. R. .................. Count o .-�- - State of /%� ...�0'-:. `t::............. . Town Yremiuni............................ ;................. Discount for approved Lightning Rod...... ......... Total...................................�.4.f�1...°= ... Date of Risk .. �'.5 .?� ..? ...�.�..........1y2. Time ...................... years. i� (ki 1.......... .................. SOLICITOR. Renewal of Yohcv 1Vo ............................. . Reinsured No..........:,:... ....:....... :...... • N�1�1�✓if�L •'��1r1r�11�:r1 • Material of house No. 2............................. Age ............ vears. In what repair ?................................ Is it necessary and remunerative in its present condition ?............... Is it painted ?............... .. Is it plastered ?............... Are the stoves, pipes and chimneys in good condition and apparently safe ?.................... Where and how are ashes kept ?........................ ........................................ ... ............................ SOLICITOR. EAST U z { O w b rdw a c o 0 WEST r O c� c 0 a� a� yr o o fh .e ......... �i ... . ip��Iacazion ��t... ��.��-.�...:�.............. �........................ i�. l . n. tio.... _....... 1 9t � c Comity of ........ 4` —4rARMERS' ...A4�n►"! Mate of 'New York, for insurance against. loss ()I*<1,111l ,re by fire or lightning iri THE MUTUAL INDEMNITV ASSOCIATION, of Cayuga Comilty, N. V. for thl, terns of ....�..........ve�l.rs from thE,... 3.. day of .... .)'...... 1192 ��, at 110011, to tile.: .��?..d�i� of..... at noun, on property located on theme.... .....side o .:...........road, .........miles frou,............................. .....in the Town of . =P� z-t-L .� .cam% - : ......... of .................. ..............-z. .and Statt� c►f Ne�� York, as follows .- A mount Insured $ ..................On Dwelling House and Attachments - ...On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises ............... .On Piano $ .................On Organ $................. On Phonograph and Records $.................. Orl.... ................................... $ ..................On Barn No. I $ .................On Barn No. 2 $ ..................On Barn No. 3 ....... .........On Barn No. 4 ..................On Hog House .................On Hen House Amount Insured $ ..................Ott Corn Barit or Uranary .................On Produce on Pretnis" ..Q...0 ..()n Farming Qtensils, Carriages, Sleiglis, Robes, I1arnem and Atltotm)hiles $..... ........ l?..On Horses $ ..................Oil Cattle �i ..............On Registered Cattle. $ ..................On slivep .$ ..................On Fowls ....... .........Oil Swine $ .................Oil ........................................................ $....... .........On ... ..... ..... $1 - d:�.Q... Total ............Rate .......... premium 1Iow many acres of land in this place?............ Wlia.t is the value of the land and buildings? $... ........ How rnanv stories in dwelling house? .............. By whom occupied?....................... .............. .................... Is it painted outside?............... Inside') .............. Is the first story plastered!.............. Second store?............... Are the chimneys all of brick?................ How hig 1-i above the roof is the lowest?..................feet. The pipes are ill good Are they in good condition? ....... condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .......................................................... Value Material How Old? I Cover Roof Condition Painted j SIZE OF BUILDING'S :Ieight of Posts lit)use ........ $............... .................................................................... ...................... ........ x......... a ......... x...... ............ barnNo. L. $............................................... ! ................ ........ ............................. ' .........x.........a.........x � 1 -,irn No. 2.. $................................ .................. j.................. .................. ....................... .,....... x ........ a........ x...... ........... BarnNo. .",.. '................................ ................. I ................................... .............................. x......... a .......... x...... ............. V ........ y�................. ................. ........ ........ ........... ......... j ......... x ........ a..... ..x ..... ..... Loss, if any on buildings, payable to.................................................................................................. ............................ ......... I ...................... Mortgagee...... , as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods?................................................................. Name of manufacturer' .............................................................. Date insta11ed? .......................... Are all rroiinc ronnections satisfactory ?............. 'Total immi-ance on rodded buildings $............... : 25 percent discount for rodded buildings $.............. Has the Applicant ever Ead a fire? ............... If so, give origin and explanation............................................. Has the Applicant any special reason to fear fire from incendiarism ?............... Is there any other Insurance on this r� erh , or anv other exposed with it, in this Comp —any ?............ If so, state amount $............. Name of Insured......................................... No. of Policy......... ........ Is there any other Insurance in any other Company? ........ If so, state amount ,pd what it covers, on back. What is your title or interest in the property? ......................................... How much is it encumbered ?.......................... ................... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind niygelf and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga Corltlty, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ............,............................................... Applicant. The. Solicitor will please answer the following Questions :— Have you carefully examined the above- risk?.............. When did you inspect the risk inside and outside? .......................... llid you then inspect, the chimneys and pipes Nliere they pass through partitions and floors and enter chimneys? .................. Are they apparently safe?.... .............. I)o you know of any facts creating moral hazard ?........... ...... ................... . ............................ ....... Sol iei tor. THE FARMERS' MUTUAL 0 0 A INDEMNITY ASSOCIATION0' � 0 of Cayuga County 00 0 0 0�---- --- ----------- 0 0 AY I I.Ol F 0 .... .... .... ......./ .......... 0 �..... .. .l.....l ....... R. D............... 0 0 C au my of.... ... ..... ............... 0 T State of........ _ .. 21 ....................... 0 .. 0 'row n of . - 0 .. 0 Premium ................:........ ................. 0 .r. 0 Survey 1{ eeA-...........................� ...... 0 0 Total. ................... Date of Risk.'' 't"4!'............. ] J•?.:. 0 1' i ire e.... ......�` ...... years. � 0 ..i • • • .. ... .. ..•- - J// 0 S 1 TOR. )LIf.,110R. d Reiiewal. c►f Policy i' .... .. �./.�-:�........ 0 Reinsured No...........:...1:...Q..�........... 1 Material of house No. 2................................. Age............years. In what repair?.................... Is it necessary and remunerative in its present condition? .................. Is it painted? .................. Is it plastered? .................. Are the stoves, pipes and chimneys in good condition and apparently safe? ....................... Where and how are ashes "kept ?........................ ......................................................................... SOLICITOR. EAST W E I I• s _ r- THE FARMERS MUTUAL p INDEMNITY ASSOCIATION of Cayuga County 00 0 A - z -TI N OF .... .... .. ................... ........ ..... 64-4 : ... R. D.. ............ . -' � County of. .................. .... Stateof .................... ..... ................... Townof......... ............ -1-- ----------- 0 0 Premium........`.` ............... ;. ,:..�...: Discount for approved 0 Lightning Rods ....................$.................. 0 0 Total .................................... $.................. 0 Date of Risk. ............ a.:..1J:?... 0 Time ........................years. � 0 0 .... .'1.... 0 SOLICITOR. 0 0 Renewal of Policy No...... ...... ...� ..... 0 0 Reinsured No.........�-„a.4..?. ............. � 111'�'�N1 Nti� �1�� .1.•� �d • Material of house No. 2 ........................... Age............ years. In what repair? ............................... Is it necessary and Is it painted ?..... Is it lastered o remunerative in its resent condition � P � P •..• Are the stoves, � pipes and chimneys in good condition and apparently safe? ..............•••...••• Where and how are ashes kept? ....................................................... ................. SOLICITOR. EAST WEST ad a3 c� L a� ao ✓ems-�—�. �Zipplication 0f#000j ...... ................. R. F. D. No ............. Postoffiice..........:�'�� County of .......................................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNI Y SSOCIATION, of Cayuga County, N, IV _ for the term�LSyears from the ....da of ...192,E at noon to h a'. �` ....... ... y .. .......... t e ..day of...................192... i at n on pr erty located on the.. ......:.. a of . ...............road, ......wiles from..`...L..in the town of ••• ••• .......... ......County of., ...... ..............an State of New York, as follows:- 4 Amount I/nsure $••L ..U. ..On Dwelling House and Attachments $.................. On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises. $ ..................On Piano ; $............... Organ ; $.............. Melodeon. $..................On...................................................... $............On..........:.............................................. =..lY....p QOn Barn No. 1 $ ..................On Barn No. 2 $ ..................On Barn No. 3 $ ..................On Barn No. 4 $ ..................On Hog House $ ..................On Hen House Amount Insured $ ..................On Corn Barn or Granary '9 .. .On Produce on Premises ..........On Farming Utensils, Cal h1ges, fileigl7s, (( Robes, Harness and Automobiles on premises $ ..................On Horses $ ..................On Cattle $.................. On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On....................................................... $....... ;>,,........On......................................................... O...&P.-O-Totall ............Date ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $.................. How many stories in dwelling house ?........... By whom occupied? ...................................................... Is it painted outside? ............ Inside ? ............... In what repair 9.................. Is the first story plastered ?............... Second story.?.......... ........ Are the clliir+neys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old? Corer Roof Condition How Finished Painted SIZE OF BUILDINGS Height House.........$............................................... .. .. of Posts .. ...... .x ........a.........x........ BarnNo. 1.. $.............................. ............. .............................................. ....... x........ a........ x........ ............ BarnNo. 2..$................................ .................................................................................x.........a........x........ BarnNo. 3.. $ ............................ ............................................................... x.........a.........x........ ............ ..................$........... ..... ................................ ...................................................... ........ x......... a ......... x........ ----------- Loss, if any on buildings, payable to ___________________________ ____________________1`lortgagee____, as -------------- Interest ---- may appear. What buildings, if any, are equipped with lightning rods?............................................................... Name of manufacturer? ••••••••••••••••••.••••••••.••••••••••.....•..................... Date installed?........................ Are all ground connections satisfactory `' ............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $........ ..... Has the Applicant ever had a fire? ............... If so, give origin and explanation ............................................. Has the Applicant any special reason to fear fire from incendiarism? .............. Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Ina ............ Insured .......................... No. of Policy............... Is there any. Insurance in any other Cornan • ?............ Company If so, state amount and what it covers, on back. What is your title or interest in the property ?.. ................................................ How much is it encumbered? $............................................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section ; of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. .....................................................................Applicant. The Solicitor will please answer the following Questions: — Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?...... .... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys,?.................. Are they apparently safe?. ... '..... Do you know of any acts creating al bazar ... ...................................%........,!:......S'oli ei'tor. 4,&J d, ► d d did dd1�d did d'W 1✓dAho,� 0 THE FARMERS' MUTUAL ' INDEMNITY ASSOCIATION o 0 0 of Cayuga County 0 0 IRo.--4_�'_a1z-________ 0 0 c� ION OF ..: ....... 0....... 0.. .......... . D./. R. ... R �� . ........ ........... County of... ....0.- .00.>�!:.. State of...... C . ..... Townof ................................................ ___----_ -----__0f-`1-� Premium.......... ................ $.,... .....�� Discount for approved 0 Lightning Rods..................J...0.......0....0. 0 �o0 Total.................................. $.l... 0 0 Pate of Risk.. .....�... ....... � . ]9• ..� 0 hl1U(' ..... ..................years. 0 0 ...... A .............. ........0 ► ...�-- SOLICITOR. 0 0 Renewal of Policy Reinsured No.'.. ..3.4., t,,. ......,........... 1v1'd'% d1✓rd j%,A"0Aj&,1 dVW'%,'d • .Material of house No. Age ............ years. In what repair? ............................... Is it necessary and 0 remunerative in its present condition? .... Is it painted? Is it plastered ..... Are the stoves, pipes and chimneys in good condition and apparently safe? .......••.••••••••••••• Where and how are ashes kept ?........... U O z H A ....................................................... .................SOLICITOR. EAST WEST oe zipplication of :. ..................... ... R. F. D., No............. . V) County of .......................................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARRIERS' MUTUAL INDEMNITY ASSQCIATION, of Cayuga County, N. for the term of.....e......vears from the. ..day of..16............ J9?.,l o the..4?,VV.dav of. .. ?�.U`4..192. at noon, on property located on the �........... ' of..................road, ..../..miles from .... .......... �:� :�:.......-in the town of .................................... County of................................and State of New York, as follows :— Amount Insured $.................. On D"-elling House and Attachments $ ..................On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises. $ ..................On Piano ; $............... Organ ; $.............. Melodeon. t $.o �a..On, . ?!!''`:................. 01 $ ..................On..... ... ............................ ... .. ........On Barn No. 1 $ ..................On Barn No. 2 $ ..................On Barn No. 3 $ ..................On Barn No. 4 $.................. On Hog House $.................. On Hen House Amount Insured $.................. On Corn Barn or Granary $A.P-i0.... On Produce on Premises (ft $...... ........... On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles on premises $ ..................On Horses $.................. On Cattle $.................. On Registered Cattle $ ..................On Sheep $ ..................On Fo wls $..................On....................................................... $.................. On ......................................................... $ 4.. :.J........Total ............ Rate ................ Premium How many acres of land in this place ?............ `'hat is the value of the land and buildings ? $.................. How many stories in dwelling house ?............ By whom occupied? ...................................................... Is it painted outside? ............ Inside ? ............... In what repair? .................. Is the first story plastered ?.............. Second story ?.................. Are the chimneys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height House......... $..... ......... ................................ .. ......... x ....... a......... x........ o osts P Barn No. L. $.... K .1.......... �0 ............ ................ �,. ........ x..........�.... BarnNo. 2..$................................ .�%.. ... ......................� ........... ......x.........a........ x........ ....... Off, .... BarnNo. 3.. $ ............................. .� .....,,.Q........................x.........a.........x........ ........... v .................. $...... .. ..... .. 7 ... .................. Loss, if any on buildings, payable to --------------------------------------------------------- -------------------- Tiortgagee---- , as -------------- Interest____ may appear. What buildings, if any, are equipped with lightning rods? ...................1..�.................... .. L,........ Name of manufacturer ? ......................•.................................... Date installed? ........................ Are all ground connections satisfactory'`. /-� Total insurance on rodded buildings $�4.:°:t?• 25 g per cent discount for rodded buildin s $........,1... g Has the Applicant c,ve�• had a fire? ............... If so, give origin and explanation ........................ 6.................... Has the Applicant any special reason to fear fire from incendiarism ? .............. Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Insured ....................................... No, of Poiic_v..... ........... Is there any Insurance in any other Company ? :: If so, state amount and what it covers, on back. What is your title or interest in the property? ................................................ .. How much is it encumbered? $........ ........................ ........ In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and lazy heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, duriug my membership. Given in pursuance of Section 7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. .....................................................................Applicant. The Solicitor will please answer the followfng Questions Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?.� 1�...... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys?. .................. Are they apparently safe?. alp..,..... Do you know of any acts creat'n�moral hazard: . ..........�!.... .......:` ....................Solicitor. S THE FARMERS' MUTUAL INDEMNITY ASSOCIATION 00 of Cayuga County 0 0 AA ll�kICIA 0 OF 0 7. h* -7 County of. .. J�... .......... 0 Stele ol........ .......... ........... ............. $ , - -0 - �-- --6-7 ----- Premium.......... ................ $-?f.. Discount for approved 0 Lightning Rods ...................4. ..... tJ�.... Total..................................�./l.�..q........ X-Ir Date of Risk.............. ........... 192./ 0 Time ........................years. . ... . ....... ....... ........... .......... .......�� SOLICITOR. 0 Renewal of Policy No ............................. Reinsured No...............3.1..t.............. 0 Material of house No. 2................................. Age ............ years. In what repair?........ ........... Is it necessary and remunerative in its present condition? .................. Is it painted ?..... ............ Is it plastered ?.................. Are the stoves, pipes and chimneys in good condition and apparently safe ?....................... Where and how are ashes kept ? a ....................................................... ................. SOLICITOR. EAST '~ a U .m ^ 0 r W Z O O H b �T4O Z r �4 H ' a cd • U 1' \• ed 0 0 0 'VEST lilicatton .. ..... .. ..... ........ . ........ R. F. D. No. ....... Postoffice.:7� ... �� of . ....... .. .. ... .. ..... County of.../ .............................. and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL I DEMNI Y S CIATION, of Cayuga County, N�J�V. for the term ............vears from the.........da of.... .... ..192,� at noon, to the ....day ofAI .........192.//7/ :1nq,.o.n on p pert-v located on tl ,..... ide off/ , .... miles f on .... - �- �,in the town of ...............road 1.... .................. ... Count of.. .....;i`�nd State of New York, as follows:— .. :........ y �. Amount Amount Insured Insured 4... .0..On Dwelling House and Attachments $ ..................On Corn Barn or Granary $.................. On Household Furniture, Printed Books, $.................. On Produce on Premises Pictures, Silver and Plate, Provisions $ .................On Farthing Utensils, Carriages, Sleighs, and Wearing Apparel on premises. Robes, Harness and Automobiles on $..... .........On Piauo ; $ ...............Organ ; $..... ..... premises M odeo /7 - $ ... ... D ..On ....... .. .... ...... $ ..................On Horses $..................On..� $.................. On Cattle $.................. On Barn No. 1 .....On Registered Cattle $.................. On Sheep $....... OdV ..On Barn No. 2 $ ..................On Barn No. 3 $............ .On Fowls $ ..................On Barn No. 4 $..................On........................................................ $ ..................On Hog House $.......... On ......................................................... $ ..................On Hen House TotaI ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $ ...... ........... How many stories in dwelling house ? ... who occupied ?....��.:.�%?:..:�- Is it painted outside?. Inside In what repair.. .... Is the first story plastered,? .:�..:;� Second story ? ........ . ... ... .. ,.� Are the chimneys all of brick?.... .� Are they in good condition ?. .. How high above the roof is the loves...... feet. The pipes are in good conditi n, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old? Cover oof Condition How Finished Painted SIZE OF BUILDINGS Height House......... $. D` .................. �. f.f .. ....................... ....... ....... of I'vsts I%yt� .Y .a. .X. .... BarnNo. L. $....... ................ � ..... ....... x........ a........ x........ ............ BarnNo. 2.. $.... ... V................................. ...............f .x �D.a........ ti........ , ``J.. BarnNo. 3.. $ ............................. ................ ................................................................. x.........a.........x........ ........... .................. $..................................................................................... ........ x......... a ......... x........ ............ Loss, if any on buildings, payable to --------------------------- ---------------------------------------------------------- --------------------rlortgagee-___, as -------------- Interest s, _ may appear. What buildings, if any, are equipped with lightning rods? :. ... ...... Name of manufacturer? ....................� ......... ........ v: •••••••............................................... Date installed ?........................ Are all ground connections satisfactory Total insurance on rodded buildings .. e........ ; 20 per cent discount for rodded buildings $.. Has the Applicant ever had a fire?' .. � ... �—�... If so, give origin and explanation ............................................. Has the Applicant any special reason to fear fire from incendiarism l_,I L...... Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Insured ....................................... No. of Poliev ..... ........... Is there any Insurance in any other Company ?. ., If so, state amount and what it covers, on back. What is your title or interest in the property ?................................................ How much is it encumbered ?$............................................ In Consideration of the Insurance obtained on property named, I do hereby give ivy Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ..................................................................... Applicant. The Solicitor will please answer the following Questions :— Have you carefully examined the above risk?L ... When did you inspect the risk inside and outside?.��•••�:6 .. ......... Did you then inspect the chimneys and pip where they pass through partitions and floors and enter chimneys? .............. Are they apparently safe?.... ........ Do you kAow of any acts creating moral hazard?....��..... .........................................�.......................... Solicitor. Y FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County, lRo. AP PLIC TION OF .. ./Z, ..... .........h. D. J.67-" .... County of.... L?� l� .� .z�l:, Stateof ..................... ......... .......... Town of...... of - - - -------------- Premium ........ 0 �. i Survey Fee.........................01 Total ..... ......... ......................� ..... rf Date of Risk... .Q'Z!`'.....�'�%......, ..lf►1 � t Time ..........6.......... years. r� SOLICITOR.► i Renewal of Policy No ... .`......... Reinsured No. •�►�s�v�+��or��vs�e�o ' Material of house No. 2................. ....... Age...............years. In what repair .... Is it necessary and ........ ..... ............ ... - remunerative in its present condition? .................... Is it painted? ....................... Is it plastered? Are the stoves, pipes a and chimneys in good condition and apparently safe ? ...... Where and how are ashes kept ? .................................. ........................................................................... SOLICITOR. C East c � rn C o � o z W = Cl O A a • c " ;Z • ►. .�.. �+ 0 M Ce ' C �" Eli 60 •r EPPItcattoll of..6 It. F. D. No....r .. Yostutfice.... W-4t��.c ....... County of ..��.. ... ... ...........and State of New York, for insurance against loss or damage by fire or lightning in the FAR ERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the term of ...... 6 ....... years from the.... ...... day of...�G.:�.`":. .11ll.�at neon, to the....: ......day (_)f..:�i lrtr`...19�.� . . at noon, on property located in the town of.....Q ............. ty of Cayuga and State of New York, as follows: Anio not ! Value of i Height SIZE OF BUILDINGS Insured Buildings of Posts On D«elling House and Atta.chments................................ $ ............. $............. ............. ' .......... x ...........a ...........x ............ On Household Furniture, Provisions and Wearing Apparelv ♦ L therein and on premises......... ... .......f / �Z Oil Piano, $......... Organ, �. Melodeon, $......... Therein ..... •• �� i On Printed Books, Pictures, Silver and,Plate therein ......... .......... 0..� , On ' ........................................................................................................................... OilBarn No. l................................................................ ............. .............. ............ x ............ a............ x............ OnBarn No. 2........ ..... ............... I..... ......... . .... , OnBarn No. 3......................................... OnBarn No. 4. .... ............................. .............. I.... ......... i.... .......... ............ x ............ a..... ...... x ............ OnCorn Barn or Granary........................................................... I .............. ............. On Produce in said Barns and on Premises ............................ �O.Q.i�. ( PRESENT NO. OF ANIMALS On .. A 0..'. ,rt'�."'�.. ......................... Horses.. Cattle............... I t ' On Farm Utensils, Carriages, Sleighs, Robes and Harnesses i pShee ................. Fowls ............... in said buildings and pelt Premises ............................ 910,0 ,,,,,,, On Live Stock, Oil Horses, $A3 ®.QOn Cattle, to -wit . 10n Sheep, $....... On Fowls, $. .�.......pu:' A a t e . J .. . �........ .......................... .. Total, - INDIVIDUAL LIMIT ON Horses $ ...............Cattle $............. Sheep $ ..................Fowls $.............. Premium .0..... ........................ Situated in the town of................................Cayuga County, N. Y. How many acres of land in this place ?............ What is the value of the land and buildings ? $................. Of what material is the Douse .............. How old is it ? ............years. How many stories ?............ For what is it occupied ......... By whom ?........................... Is it painted outside Inside ? In what repair ........... Is the first story plastered ?............... Second story ?............Are the chimneys all of brick ?......... Are they in good condition ?..... .. How high above the roof is the lowest ?........ feet. The pipes are in good condition, safely tseciired and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in ................................................. Barns —Material. How Old? Cover of Roof. Condition. How Finished ? Painted. No. l ................... ........................ ............... ........ ........................ .......................................................................... No. 2............................................. ....................... ...... ................. .......................... ....................... I....... .................. No. 3...................................................... ' .. .............................................................................................. ..... ........ ........................... .. ............. ....... . I . . . . . . . ................. .......................... .......................... ....... .............. i........ ........ ......... Loss, if any on buildings, Payable to.......................................................................................................................... ....................................................................................................as............................. interest ............ may appear. Has the Applicant ever had a fire ?.............. If so, give origin and explanation....................................... Has the Applicant any special reason to fear fire front incendiarism ?............ Is there any other Insurance on this property, or any other exposed with it, in this Company ?............ If so, state amount $ . Naive of Insured......... T ............................................�o. of Policy ... ............... Is there any Insurance in any other Company ?............ If so, state amount and what it covers, on back. What is your title or interest in the property ?........................................................... How much is it encumbered ? $..................................... In Consideration of the Instrance obtained on property named, I do Hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rats share of all liabilities incurred by the Association, and all losses by Fire or Lightning, su9tained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organ - zed and in conformity with the By -Laws of the Association. ........................................... .0 - ... ... ... ................ ... A pplican t. The Solicitor will please answer the following Qtiestions:— Have you carefully examined the above risk ?............ When did you last examine it ? ............................... Dill you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys ? ...................Are they apparently safe ? .................. Do you know of any acts creating moral hazard ?............ Date of Ins ection..; G:yrF�.. .191. ... .:'1...... ... .. Solicitor. p �'` .. . S tor. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County 0 ---------------- 0 CATION OF .. ..... ........ ................. ........ ........R. D.......... ......... County of.: .. ..... . ...... ........... Stateof .................. ..... ...................... Townof. ...... .... ............................ 0 Premium.......... ................ $..... ............ Discount for approved 0 Lightning Rods .................. ................. rotnl.................................... s.C,�...a�v�...... Date of Risk.... 192 Time ............. P ...........yearn. ..... ... SOLICITOR. Renewal of Policy No... .. ........Ir:....... 4 Reinsured No....... .... Material of house No.`_'.................................I Age ............ }•ears. In what repair"............ Is it necessary and 0 remunerative in its present condition? .................. Is it painted ?..... ............ Is it plastered ?.................. Are the stoves, pipes and chimneys in good condition and apparently safe .••....•.. Where and how are ashes kept?........... a U ................. • ......... 0 • ............ • .... .....SOLICITOR. 3 EAST NEST 0 � o W c� 01 i � c b .0 m L � lipplication .... ......... .......... .. ....... .. R. F. A , No ............. Postoffice ........................................ County of ..................... . L .................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. L for the term vears from tlier,�Y.Afly,�U .— , . ..... 192.2�--at noon t��e ;-7-- v of... ,! ... V ..... -,day ... 192(,3 0 ... ...... . ......... oad, in the town of at on _p _erty located on the...A ....... . ............. ..... County of......' ... . ........ . and State of New York, its follows 7 - Amount Amount Insured Insured $ .`........On Dwelling House and Attachments ..................On Corn Barn or Granary $ ... 3.5* �....On Household Furniture, Printed Books, b. /0. P. 0 ...Oil Produce on Premises Pictures, Silver and Plate, Provisions $ .... 40-0.0-On Farming Utensils, Carriages, Sleighs, 6`0 and Wearing Apparel oil premises. Robes, Harness and Automobiles on $ ..................On Piano ; -0 ............... ........ premises Melodeon, 0 $ ....On $.....A..On Horses $ 0:........ .............. $...%5_9§52..On Cattle q- $ tu A $ ..................On Registered Cattle $ ... .... !i'....On Barn No. 2 $ ..................On Sheep -A $ ..................On Fowls /SE. 0 n $ .................. On ............... ........................ ................. .r6m **wt, $ ....... Hog House $ .................. On ......................................................... $ .........� ..On Hen House $ 4,J .. Total ............ Rate ................ Premium How many acres of land in this place ?1.1�� What is the value of the land and buildings? $ ................. How many stories in dwelling house ? .... By whom occupied ?.. ............................... Is it painted outside? Inside? .... In what repair ...... ... Is the first ftory plastered Second story . . . ........... re the chimneys Are th in go ;k� ...........feet. The pipes are in co all of brick condition How high a ve the roof is the low st ? good conditi4n, safely secured and enter the chimeey horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .............................................................. Material Value How Old? Cover Roof Condition How Finished Painted SIZE OF BUILDIN 3_1 Height. of Poses House......... $ ..... ......... . ............... ................. ..................................... .................. xJK. . a......... x.... i- Barn No. L. $ ................. ............. ................ ............... ....................................... a/(;.. x.k.! .. Igo BarnNo. 2.. $ ...................... ............ ................ I ........................................................ . 2_6 ... xd..a........ x ........ .... Barn No. K$ ....'.:.x. 1� . a ......... x ........ ..... .................. $ ........... ................ ..a ......... x ........ an o bip dings, pay to --- -------- ------------- - ------------------ Loss, if n .1 ay to -------------- - --_11ortgagee____, as_____ ------ nterest----ma6aappear. 00, What buildings, if any, are equipped with lightning rods? ................................... .................. .......6. Name of manufacturer? .................................................. ............... Date installed ? ......................... Are all ground connections satisfactory ? ............ Total insurance on rodded buildings $ ............... ; 25 per cent disco rodded buildings $ ........ ..... Has the Applicant ever had a f1re?.`K/..2'... If so, give origin and explanation .............................................. Has the Applicant any special reason to fear fire from in�diarism? Is there any other Insurance on this property, or any other exposed with it, in this Company ? ................. If so, state amount $ ............'Name of Insured ............. ......................... No. of Policy.... ........... Is there any Insurance in any other Company state amount and what it covers, on back. What is vour title or interest in the property? .......... ................ How much is it encumbered? $ ............................................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the Said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the. Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. n.0 ....... . a. Applicant. The Solicitor will please answer the followfng Questions :— Have you carefully examined the above risk?. -/.X-Q,_When did you inspect the risk inside and outside?..... Did you then inspect the chimneys and pipes here they pass through partitions and floors and enter chimneys.'.... �......... Are they apparently safe?. Do you know of any acts creati nZ, moral ha ard?._J.- Solicitor. ... . ... .. ........... THE FARMERS' MUTUAL 0 0 o INDEMNITY ASSOCIATION 0 1 of CayugaCounty 0 IROO_______________________ -------- 0 0 0 A P -jICAT10N QF 0 ....... .R D. d Countyof .............................................. Stateof ........................................ Townof ................................................. 0 0 �. i� Sur�e3 Fee ...........................$.................. �p 0 r,)tal...........,....................................... 0 0 - 0 Date of Risk. �Q!.L.....................19?� Time........! ............... ears. 19 - ( .............. 140 S ICITOR. 0 - 0 0 Renewal of Policy No......00 ....... Reinsured No ....... .i'1z.0;.�.17..,3.......... 0 Material of house No. 22.................................. Age ............ years. In what repairs ..... Is it necessary and ............................ remunerative in its present condition? ...... Is it painted? ................. Is it plastered? .................. Are the stoves, pipes and chimneys in good condition and apparently safe? ....................... NAThere and how are ashes kept? ......... .............. Cd 0 C Q � O C C Fs c�a eo � V ' H d a A O o C 64 GOD. vio H ' O z ......................................................................... SOLICITOR. EAST rivIm �- (F Isam H O , , V, .. . G.....-! ........... R. F. D. No ............. Postoffice........ .� .Q. ... application of....... % �. c� r County of...✓•e......... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayu County, N. for the term of...� ..........vears from tbe.l..l�..... day o4an 192 at noon, t% ...day of .. '....at noon, on property l,ocated on the.��`�side oftb'sad, f ...miles from... �.. ...in the town of .. ..�.i . v&ounty of ...... .. ..... ......... State of New York, as follows: — Amount Amount Insured Insured $..1--e..��...V.On Dwelling House and Attachments $ ..................On Corn Barn or Granary $....J�.C�. ..On Household Furniture, Printed Books, �.... ..�1.....,..0n Produce on Premises Pictures, Silver and Plate, Provisions Apparelpremises.$•••• ••G••�•••On Farming Utensils, Carriages, Sleighs, and Wearing A pp on Robes, Harness and its no files on $ ..................On Piano ; $............... Organ ; $.............. premises 0M -CA Melodeon. $..................On......................................................... $..................Orr Horses . $... .....On......................................................... $.................Orr Cattle 40/0�� Q` On Barn No. I $.................. On Registered Cattle $..�. ......... $ ..................On Barn No. 2 $ ..................On Sheep $..................Oii Barn No. 3 $ ..................On Fowls $ ..................On Barn No. 4 $..................On........................................................ $ ..................On Hog House $............. ....On............................. .. .................. $ ..................On Hen House $.3.... ......Total ............Rate ; f..... Premium How man acres of land in this lace ........... What is the value of the land and buildings . $.... . d many p � � g � � ... How many stories in dwelling house ?..��.�... B whom occupied ?A .t. j. .. "rA. 2 ........... Is it painted outside? Inside �j 17 �/, 3 p .... Second story ...ld ..... In what repair ... ..l",.f. .�. Is the first story plastered ...ldC �...... Are the chimneys all of brick Are they in good condition ?.a.1^ How high above the roof is the lowest ? ..'......feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood a.hes are kept at least thirty feet frorn any insured building or in.... Material Value How Old. Cow Roof Condition How Finished Painted SIZh; OF BUILDINGS Height ff Q of Posts House......... $... tl �© ............. ....... �'. �.!?�l...................... .... ...... � __x�� l_a------1----- -- -- Olt Barn No. L.$ ............................... ... �(........ .U.��!?�... ..........................Cliff �.... � _x(_oya------`�------------- EarnNo. 2..$................................ .........................................................................------ x------ a ------ x----- BarnNo. 3.. $ ............................. ................ ......................................................------ x------ a ------ x- .................. $........... ..... ............... ................. ........................................................ ------ x------ a ------ x----- ,,��^^ rye '.�fa i �`• Loss, if any on buildings, payable to _y_r_ _ _ _ _ _ __'`-_ _ : _ _ g ,f — —.— .j - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — --------------------Clortgagee---_, as -------------- Interest-_-_ may appear. What buildings, if any, are equipped with lightning rods?............................................................... Name of manufacturer'.' Date installed ? .. Are all ground connections satisfactory ?........, Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $........ ..... Has the Applicant ever had a fire? ............... If so, give origin and explanation............................................ Has the Applicant any special reason to fear fire from incendiarism? .�..Q... Is there any other Insurance on this property, or any other exposed xvith it, in this Company ?...&.19... If so, state amount $............... Name of Insured................... T .................... No. of Policy................ Is there any Insurance in any other Cora any? ............ If so, state amount and what it covers, on back. What is your title or interest in the property ?......... How much is it encumbered? $............................................. In Consideration of the Insurance obtained on property named, I do hereby give my Undertakings, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, dur•iug my membership. Given in pursuance of Section '7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. .................... Applicant. t. The Solicitor will please answer the following Questions :— Have you carefully examined the above risk?..r1j ... When did you inspect the risk inside and outside?.� .....d.......... Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? ... Are the apparently safe? .� ....... Do u k ? L� ....... y pp y • � you now of any acts creating moral haz rd ...0.0 ....... P OF ..... - .... ... X. .........Solicitor. ER Im PSI N,,flTU 0 T I E F A AL 0 1 O`" l Hii I T Y A S S I A 10 uft N 00 0 0 �APP:�� IC. ' ` '�T C) �' 0 .� �;'.. 0 ............................................. R. D. 0 County of............ 04-2.... ...... ................. 2State of........ .. .. ............ Cow n of........ .............. 0 0 PPremium ..... ..... ................. .. ... ............ 0 0 Total.................................... 0 Date of Ri=k...... 1 ... :...1......19?r. 0 ...............years. C 0 - -t--- SOLICITOR. TOR. _ 0 henew al of Pulicv N o................. Reinsured No...4":.. ..5 `..++ ...e ............... 0 Age••••••••••••years. In what. repair' ............................... Is it ne-essaty and Material of house No. remunerative in its preset condition? .................. Is it painted?................. Is it, plastered'................. Are the stoves, pipes and chimneys in good condition and apparently safe? ....................... «'here and how are ashes kept?......... ............... G H 1"1 w 0 O O O Gore ihr :.h. ......................................................................... SOLICITOR. EAST NV E r Application ............................................... R. F. D., No............. PostoHice..... ............................. County of .... 6..., ....... fist............. and State of New York, for insurance against loss or damage by fire or lightning in TH FA MERS' MUTUAL INDEMNIT ASSOC ATION, of Cayuga County, N. , . for the term c�...... years from t}ie......... day of ....... ..............19? at noon, to t}ie..... day of...... .... t oo on pro erty loz.ted on t} ........side ................road, .........miles from .................................... in the town of ....County of.. d State of New York, as follows :— Amount Insured $.. 49.�...On D%,,-elling House and Attachments $ ..................On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises. $ ..................On Piano ; $............... Organ ; $.............. Melodeon. $..................On.......................................................... $.................On......................................................... a'J@. .0 ..... On Barn No. I $ ..................On Barn No. 2 $ ..................On Barn No. 3 $......... ......On Barn No. 4 Amount Insured $ ..................On Corn Barn or Granary $ ..................On Produce on Premises $ .................On Farthing Utensils, Carriages, Sleighs, Robes, Harness and Automobiles on premises $ ..................On Horses $ ..................On Cattle $.................. On Registered Cattle $ ..................On Sheep $ ...................On Fowls $.................. On ........................................................ $ ..................On Hog House $ .................. On ....................................................... .. $ .................On Hen House $. .Total ............Rate ................ Premium How many acres of land in this place ?............ 117hat is the vplue of the land and buildings ? $................. How many stories in dwelling house? ............ By whom occupied? ........................... ......... ............ Is it painted outside? .... Inside? . ... In what repair ?.;,� :i::I!'z : Is the first story plastered ?..rve ....Second story?..re the chimneys �-�oof brick ?.. Are they in good condition ..... How high abe roof is the lowest ...........feet. The pipes are in good condition, safely secured and enter the chimn,.v Horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height of Posts House.........$...................................................................................... ................... ......... x ....... a......... x........ BarnNo. L. $.............................. ................ i ....................................................... ....... x........ a........ x........ ............ BarnNo. 2..$ ............................... ................ ................ ................ ......... X... . ..... a... ..... x........ ...... ..... BarnNo. K $ ............................. ................ .................... .... .. .................. $............................. ....................................................................... ........ x ......... a......... x........ ............ Loss, if any on buildings, payable to------------------------------------------------------------------------------------- --------------------11ortgagee____, as -------------- Interest_--- may appear. What buildings, if any, are equipped with lightning rods?............................................................... Name of manufacturer? Date installed ?........................ Are all ground connections satisfactory ?............ Total insurance on rodded buildings $............... : 25 per cent discount for rodded buildings $........ ..... Has the Applicant ever had a fire? ...-� .... If so, give origin and explanation ............................................. Has the Applicant any special reason ......... to fear fire from incendiarism ?>Lf_1 ........ Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............... Name of Insured...... No. of Policy............ Is there any Insurance in any other Company? ............ If so, state amount and what it covers, on back. What is your title or interest in the property ? .................................................. How much is it encumbered? $........................................... In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. ....... . t...Applicant. The Solicitor will please answer the followfng Questions Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?.............. ............ Did you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimneys? .................. Are they apparently safe ?.................. Do you know of an 2 y acts creating mo al hazard? .........:�..... .... . i. .........Solicitor. THIS POLICY IS ISSUED ON THE CO-OPERATIVE PLAN N0.21019 --------------------- $ _IQ 00 go ------------------------ THE FARMERS' MUTUAL INDEMNITY ASSOCIATION OF CAYUGA COUNTY Ott 0,30tuibezatio+V of tfw, fwzzei+t tv a m ob and of the statements and representations contained in the application and survey for this policy and of the observance by the insured of the by-laws endorsed on the back hereof, and of the payment of $------------------------------- Membership Fee; Two 00/100 $ ------.Policy Fee, > ...... --•---------------------------------------------------------------------Dollars by the insure , to wi : < = Survey Fee $ ------------------------------- Percentage, If Does Insure .-----------•-------------•-------. E ................................... Tomlinson ---------------------------- -............................. -................ -................ ---------------------------• --for the term of ........ three -----------------------------------years fromthe ............................... 201h------------------------------ day of -------- Qet-o er--------------------------S-192-1----------, at noon, to the-----------------------------------6t i------------------------------day of--------S�0 ober---------------------------192A---------- at noolt, _, against all direct loss or damage by fire, except as hereinafter provided, To an amount not exceeding------ One --- tlaouaand---- -------------------------------------------------------------------------------- Dollars, to the following described property while located and contained as described herein, and tint cbselnccre, to tr:--it.: ........On Dwelling House and Attachments ........On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and wearing Apparel on Premises $ ........ On Plano ........ On Organ $........ On ................................. $........ On ................................. $........ On. Barn No. 1 $ ........ On Barn No. 2 $ ........ On Barn No. 3 ........ On Barn No. 4 ........On Hog House ........ On Hen House $- ....... On Corn Barn or Granary . 1000 .On Produce on Premises ........On Farming Utensils, Carriages, Sleighs, Popes, Harness and Automobiles on premises (See Section 29 of By -Laves.) ........ On Horses $ ........ On Cattle ..... On Registered Cattle $ ........ On Sheep $ ........ On Swine ........On Fowls ........On .Qther, insur�:�e. 1�ex'ttt.�d ........ On .. Q ©11GUP.r0nt 1y ............... . 1QQ0 . Total ALL SITUATE on and contained in the premises owned and occupied by the insured in the Town of or or ------------------------ ----------------- proton--.------------------ County o f ----- T -om-king ------------------ ---------State of New York, and as described in the written application for this htsu ranee, which is hereby made a part of this 1-tolicy. New York Standard Co=Operative Lightning Clause This policy shall cover any direct loss or damage caused by Lightning (meaning thereby the commonly accepted use of the term Lightning, and in no case to include loss or damage by cyclone, tornado or wind -storm), not exceeding the sum insured, nor the interest of the insured in the property, and subject in all other respects to the terms and conditions of this policy; provided, however, if there shall be any other insurance on said property, this company shall be liable only Pro rat& with such other insurance for any direct loss by Lightning, whether such other insurance be against direct loss by Lightning or not. Live Stock insured by this policy is covered against death only directly caused by Lightning (meaning thereby the use of the term Lightning as above stated), in said barns or while at large on owner's premises or elsewhere within the territorial limits of this company.