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HomeMy WebLinkAboutCreate a B&W TIFF image file_1_20250212144307588THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County 0 A LIC TION OF .... ............ 0 R. D..... .......... I... 0 Countyof..... ........................................ State of ......... Town of ............ -- Premium............ .................. $..... // Discount for approved Lightning Rods..... .............. $........ . Taal .................................... �.. ... d . Date of Risk- .. ..... Time ...................... years. .... SOLICITOR. Renewal of Policy ` .. •- �-- .-......�. Reinsured No............ ...... r Is it necessary and c Age............years. In what repair? .................... ° .......... Material of house No. 2.............. m 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. 3 EAST a ° bo o Z z H � rs vD. 0 n c c C ' r C r C c � � o �U A >� E-F � � m bm G b ago a a � ° ° x WEST w err Q�J�1�iL"A it Of. .............................................. It. F. i)., No............ Postotiice. ... ...... County of ..... ..................and �tai.� of New York, for insurance against Inns or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of_.:...... ....... years from the/ .., day ..................It►'�, at noon, to the/ .....day of. 1 .....19. . at nor), on property located on tI)- ..........eside ,El. road l noi.les ' ........ m the town of ,1,...County c .. ..1� ?"- ......................and State of New York, as follows :— Amount Insured $-11.0-0... 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........................................ ...On Barn No. l 9t- ctiLc.Q� yv,o $•••.�..On Barn No. 2 $ ..................On Barn No. 3 $.............. .On Barn No. 4 $........ `�. On Hog House ...... Q ...On Hen Hous Amount Insured $......... 7- ..On Ciorn Barnf�rrnt��►-- $...............:.On Produce on Premises $................. On Farming Utensils, Carriages, Sleighe, Robes, Harness and Automobiles $ .................On Horses $ ..................On Cattle $ ..............On Registered Cattle $ ..................On Sheep $ ..................On Fowls ......... Oil Swirie $.,.3.t�, �1„„���XX..On ............ ...... I .......... ... I.................. 91"a- ITot aI ............Rate ........... Premium How many acres of land in this place?............ What is thr� value of the land and buildings? $............ flow many stories in dwelling house? ..... I/.... By wham occupied?.........aH. ___1 . .................... ............ Is it painted outside?. ...... Inside? , .. ..... Is the first story plastered`?.. Second story?. Are the chimneys all of brick .....: ..... Are t in ood condition?... ...... • high above the roof i, the lowest?.......... �.. .....feet. The pipes are in good condition, safely secured and nter t e chimney horizontally by a thimble or are firmly cemented therein. All woad ashes are kept at leant thirty feet from any insured building or in .......................................................... Value Material How Old? Cover Roof Condition Painted f SIZE OF BUILDINGS Height 1-louse ...... $.. ...... ...... .......... I of Posts BarnNo. L.$.......................................... ...... .. llarnNo. 2.. $.............................................................. .. x ........ a......... x...... ............ Bar„ No. 3.. $................................ .............................. ................................ .......................................................................... .........x ....... a..... ..x ..... .............. Loss. it any on buildings, payable to -! --A.Z ..... �`'TJ-L�f/...............7 ................................................ .:............................... Mortgagee..... , as................ Interest...... may appear'. ` What buildings, if any, are equipped with lightning rods?..-.al1l� ..�.X?G� �► �.................... Name of manufacturer? •••••••••••••••••••••••••••••••••••.....•••.......••••••...... Date installed ?......... .................. Are all ground connections satisfactory ?............ 'fatal insurance on rodded buildings $....i.��.%.`J 25 percent -discount for rodded buildings $•i• i�(i�t.,.. Has the Applicant ever had a fire? ........... I... 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 Poliev.................. 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 Undertakin„ 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. PP The Solicitor will please answer the following Questions :-- 6 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 flnnru ir,rl FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County. .� lRo*-/F APPLICATION OF .......... R. D ................ County Of .......... Stateof'....141 ....... ....................... Town of ...... ------------------- 0 Premium............................. ...... Survey Fee............ -........ .......... ......... Total ................................... $ Ac ... Date of Risk. Time ........ ..............years. ..J. X SOLICITOR. Renewal of Policy NO ......... Reinsured No ...... Is it necessay and In what repair ? .............................. ........ Age ........... years. Material of house No. 2 ? ........ ................ condition ? ....... ...... is it painted ? .................. Is it plastered? ............ Are the stoves, pipes remunerative in its present c and chimneys in good condition and apparently safe ? ........................ Where and how are ashes kept ? ....................................... SOLICITOR. East P-4 Z 4.2 $� 0 O z 0 4-D 0 Isom Ztpp[tcation of ��� .. .... `Z�'L... �'� .�' ......... >.. F. D., No......... I�otr�l ce....... . ` ' .... - J 2�.:g County of. . �: �'.�. �.(��t+, .:z' ...........and State of New York, for insurance ��pj►in�t loss .r c,r damage i,y fire or lightning in the FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. V., for the term of... .... j'.........Years from the .day of.rfl �1...........191., at noon, to thil'"..d<ty nf...... ::.y ..........lf)�z... at noon, on property located in the town of: f.............. 'r Count '" . • ......•••• y of Cayuga and State of New York, as follows Amount Value of Height Insured Buildings' of Posts SIZE OF BUILDINGS On Dwelling House and Attachments ....... +.........%�.............................. x............ a ............ x............ On Household Furniture, Provisions and Nearing Apparel I therein and on premises ....................... ...............! ...... ....... l $......... _ , $.........therein ...............1 On Piano, ?+. Oman, '1Ielodeon i On Printed Books, Pictures, Silver and Plate therein ...... ............... c)n................. ................ ......... ..................................... ....� � .............................. OnBarn No. 1....................................... ........................... / .............................. x a x On Barn No. 2..................... ..... ....... ........... ...... ...... ...... ....... ............................ x........... a............x............ On Barn No. 3...... ....... ............... ................... ' ... .... .... ...... OnBarn No. I ......................................................... x a x OnCorn Barn or Granary ................................................ ............... ............... ............... ............ x............ a ............ x............ On Produce in said Barns and on Premises .................................... PRESENT NO. OF ANIMALS On............................................................................... ............... i...... ....................... Horses............... Cattle............... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep,,,,•.•,,.,,,,. Fowls ............... I in said buildings and on Premises.........................................j i INDIVIDUAL LI MIT ON On Live Stock, On Horses, $...... . On Cattle. $........................i Horses $............... Cattle $............... to -wit : On Sheep, $......... On Fowls, $......... Sheep $............... Fowls;............... Rate................................ .................. Total -/ Premium........ ......... ....... ....... Situated in the town of..........................Cayuga County, N. Y. How many acres of land in this place I............ What is the value of the land and buildings ? $..................... Of what material is the house ? ..................... How old is it ? ............year�s How many stories ?............ For what is it occupied ?..................... By whorn ?........................ Is it painted outside ?............ Inside ?............ In what repair ?............... Is the first story plastered ? .............. Second story ?.............. Aro 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 ................................................... I I I f,arns—Material. How Old? Cover of Roof. Condition. How Finished ? fainted. \o. I ................. i.......................... ......................... ......................... I ................................................ ........................ . No. 2.................. I................................I................. I ......................... I ............. .................. ........................................................'................................................ .......................................................................................................................................................... .......................... Loss, if any, on buildings, payable to.................................................................................................................... ........ .............................. .................................................... ......... .as .................................... Intere .......... st. .may appear. Has the Applicant ever had a fire ?........... If eo, give origin and explanation .................................... Ilas the Apphearit arly special reason to fear fire from incendiarism ?..... ...... Is there any other, Insurance on this prop, rty, orany otherexposed with it, in this Company 9............ If so, state amount $............ Name of Insured ................. ..........................No. of Pvlicv.........,..... Is there any Insurance in any other Company 9............ If so, state amount and what it covers, (;i, back. What is vonr title of interest in the property?............................................................ How nrltch is it erlcnmbercd ? ........................... ... . In Consideration of the Insurance obtained on property nailed, I do hereby Vive my Undertaking, whereby I bind myself and my heirs, execl7tors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga Cmmnty, N. Y ., my pro rate share of all liabilities incurred. by the Ass )ciaLion, and all loses b�, Fire or Lightning, sustained by any member there, f, during ray membership. Given in pursuance of Section 7 of the Act raider which the Association i;+ organ- ized and in conformity with the By -Laws of the Association. ................................ .................. ........... .................... ..I.. ............... Applicant. The Solicitor will please answer the following Questions:— THE FARMERS INDEMNITY ASSOCIATION of Cayuga Count y Mo. ------ �_ & -443 ~ -0 LI N OF ......... ........ D.......... Countyof..... ....... .. ..................... State of............ Town off. ... .......... . ...... Premium..............................$.....ff, ......... Discount for approved & 0 Lightning Rods ..................... $....... ........ 0 Total.................................$... ..f .. Date of Ri ..............192 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?.........:................. r- ............................. ............................ SOLICITOR. EAST WEST ��ICPId P. F. D., No............ Posto e....... onnty of....... rARMERS' ...........and State of N �,rk, for insurance against loss or damage by fire or ]ightning in THE ,IUTUAL INDEM 7 Y ASSOCIATION, of Cayuga County, N. for the term ...... ears fro the..... Y day l i)�� Iloon, to ie.. ..day at�Ot.)..pl.(.).Pertv located on t} sld of-.... .....toad, ...�...rnrlf.s fro in the Town�of .........;� 6` ... . ........county o ...... ............. id State of New York, as follows: -- A mount Insured .....On Dwelling House and Attachrnerlts ................ On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises �............... .On Piano .................On Organ $ ..................On Phonograph and Records $ ..................On.... ....... ...... ...................... s•/.....&.011 Barn No. 1 ..................On Barn No. 2 .................. On Barn No. 3 u� ....... .........On Barn No. I .................On Hog House .................On Hen House Amount Insured .................On Corti Barn or Granary .On Produce on Premises .... .. (Tn Farming Utensils, Carriages, Sleighs, Robes, Harness and Autonlobiles $ .................On IIorses $ ..................On Cattle .............On Registered Cattle .....On Sheep ...............On Fowls ..............On S w i 5A,_ ........011.................. .Xr:�::. . r... .......... dotal ............Rate .......... Premium How many acres of land in this place?............ Wllat 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 ............... r "' " A e the chimneys all of brick ..... Are they in goo condition ?..................... How high above the roof is the to �.. west?..................feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All world 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 House........ $............... .... ............................................................... of Posts Barre No. I_ $ ...... ........................... ........ f. x.........a.........x..... . ,/ Barn No. 2................ ............._.. .....................�� .a.........x ..... �`� ........ ............. Barn No. 3.. $ ................. ..................$ ................. .............. .........,....... I................................... ..................... x......... a ......... x...... ............. ......... ........ ........... ......... ......... x ........a..... x ...... .............. Loss, if any on buildings, payable to............. ................................. Mormagee..... , as............... Interest ....may appear. What buildings, if my, are equipped with lightning rods � N .............. ...... .............................................................. Date installed ? ...................... Name 1 ann ctur< r . of n fa � `? ......••.......•••••...... Are all ground connections satisfactory ? Total insurance on sodded btlihlinge .�,.,.,, • 20 percent discount for sodded buildings g .. e 5••••�...... 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 thi9 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 bare.. 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 assiins 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. 0 ............. ............ Ap ficant. The Solicitor will please answer the Following Questions:— Have you carefully examined the above risk?�' When did you inspect the risk inside and outside?.... 1 you then Inspect the chimneys a.nr� ,); ' a .x,t,o,.o +t,,,__ THE FARMERS' MUTUAL S INDEMNITY ASSOCIATION 0 of Cayuga County 0 0 0 L� _ S AT19 OF i ..... .�.. R. D ................. County of. . . ...............I........ Stateof... ... .......... I................... Townof ......... ...............r...... ....... 0 1------------------------- Premium.......... ................ $..... ......... Discount for approved Lightning Rods $ •• .... Total..... ...................... ........$. ....... — Date of Risk...... � .•7'•.....192/ Time ........................years. "0 ........ #11 ........ ... 0 SOLICITOR. Renewal of Policv No ''17L Reinsured No ............................................ Material of house No. 2' ................................. Age............ years. In what repair? ............................... Is it necessary and Is it painted? ..... ......... • • • Is it plastered? .................. Are the stoves, remunerative in its present condition? .................. apparently safe? Where and how are ashes kept? ........................ pipes and chimneys in good condition and app Y """"""' ...........................:....................., .... .................SOLICITOR. EAST o z 0 �L-4 O Z H A WEST y w zip 1, P icati R. F. _.D., No ............. Postoffice ............ .... and State --o;-New_-York, _for insurance against loss or damage by fire or lightning in County of THEZARMERS' MUTUAL )NDEMNIT IATION, of Cayuga County. N for the term Ot-.�­� ......... years from the at 9___ day of.T..=-J92./ at noon, to the .day ox--:�<..192.�� e .................. r the town of �0.,on ropertv located on theAO;.� -d ......road ...................... I ..................... County of. ..... ................. an -State of New York, as follows Amount Insured Aniount Insured $ .................. On Dwellina House and Attachments $ .................. On Corti Barn or Granary $ .................. On Household Furniture, Printed Books, $--A'"On Produce Pictures, Silver and Plate, Provisions on Premises and Wearing Apparel on premises. . $ ...... ........... On Farming Utensils, Carriages, Sleighs, $ .................. On Piano ; $ ...............Or an ; $ .............. Robes, Harness and Automobiles on Melodeon. premises $ .................. On .......................................................... $ .................. On Horses $ ..................On.................................. $ .................. On Cattle $ .................. On Barn No. 1 $ .................. On Registered Cattle $ ..................On Barn No. 2 $ .................. On Sheep $ ..................On Barn No. 3 $ ..................On Barn No. 4 $ .................. On Fowls $ .................. On.. W.. $ ..................On Hog House .................................. $ 0 . ... .................. .................. On Hen House $ ..................Total ...Rate 1P ...........Premium How many acres of land in this place ? ........ What is the . value of the land and buildings ? $ in dwelling house ? ............ By whom occupied? ....... ......... HOW many stories es ...................................................... ............... In what repair ? .................. Is the first story Is it painted outside? ............ Inside ? plastered ............... Second story? .................. Are the chinineys 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. are kept at least thirty feet from any insured building or in All wood ashes Material Value How Old ? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height House......... $ ..... ......... . ............... ................. ................. of Posts BarnNo. I..$ ................. ...... ....... I ................ ................... . .................. ......... ............ ................ .............. i Barn No. 2.. $ ................................ ................ ......... .................. ....... x ........ a ........ x ........ ............ .................. ............ BarnNo. 3.. $ .... .. ........ ............... .......... ... I ....... ...... ......... x ......... a ......... x ........ ...... ..... .... .......... I ................. .................. $ ........... ..... ............... ... . ................. .................. ......... x ......... a ......... x ........ ............ ................. .................. ......................................... ........ x ......... a ......... x ........ ........... Loss, if any on buildings, payable to -------------------- r1ortgagee ---- , as -------------- Interest ---- may appear. What buildings, if any, are equipped with lightning rods? ........ ............. ............................ . ............. .................. ......... Name of manufacturer ? ..................................... .... .. . . . Total insurance o n rodde d . build . i . n . gs .. $ Date installed? ........................ Are all ground connections satisfactory' ..... •....... ; 25 per cent discount for rodded buildings $ ........ ..... Has the Applicant had a fire?...... ......... If so, give origin and explanation.. ........................ ever to fear fire from incendiarism ? ........... ................... Has the Applicant any special reason Company ? ............... ... Is there any other insurance on this property, or any other exposed With it, in this If so, state amount $ ............... Na )e of Insured... No. of Policy ............... Is there any Insurance in any other Cornpany?.�, . if or interest in the property? 61 �a�so, state amount and what it covers, on back. What is your title . ................... ............................... How much is it encumbered? $ InConsideration 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, slistained bov any member thereof, duriug my membership. Given in pursuance of Section "I of the Act under which the Association is Organ- ized and in conformity with the By -Laws of the Association. . ..... .... The Solicitor will please an8wer the following QuestioRs . : . ......................................................... Applicant. 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 Dartitionq and A— I tARMERS9 MUTUAL 3 � ` INDEMNITY ASSOCIATION 3 of Cayuga County onoommmomaoen000000t�oomnom00000aooean0000caoor000a ilia ocmmmcecommmevam000aaammm�amm4aecmmmmmm; APPLICATION OF D ...... ............. ......... County of ..✓.??. ..... State of ...... .-elr Townof . .............................. ; eo�aeno�oaoamm000mo�0000e0000aooaooaeooans���eaooa000 3 eoaceaeeaaac00000noocm000c�moa000r�ocon�ov000urnacc000 1� 3 Premium ........ ..........$. ...... 1 23 Survey Fee ................�../ o-v ..... 1 J /✓ cner0000reooaenoeomm • rreaooeoeoeorc�o�00000000c00000no 7 Date Risk .. .. Time. ......... years. roroacaoc�oc000eoaana000co��ayy000amr•�cmaomoamoeoo�cnooc � � .......� ... 3 i SOLICITOR. � cecoaoeo�00000maooeao©on000moo�0000000mr•.anoncnaooaoaa Renewal of Policy No. ...... :Reinsured No ............................. wwwVVWWVY ~A�wwww: 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 P4 and chimneys in good condition and apparently safe?.. ................ Where and how are ashes kept?......... ............. .. ........ .. .. ............ ... ...............SOLICITOR. C East a o w c i z4-4 c z rc O O ce ce P _ r. — C u :. • O O O 'c y � ���`� 14 iPPlfcatfonof .......... ... .G� . U.J. G.. .. .......................... ......... ........ ................ . R. F. D. No . . , , . P. O. . ..... . . . ..... . . . . . . . • , , , , 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. Y., in the sum of ....... � .' • • a t_x G! !!` , . ` ...........DOLLARS for the term of, LL 7 ..... years, to wit: Amount Value of Height SIZE OF BUILDINGS. Insured buildings of posts ON Dwelling House and Attachments l,4A. 4 �Xi.xz4; a. �i,..x� - z. ON Household Furniture, Provisions and Wearing Apparel therein and on premises. �!�ri�, , G�- lL .. , , , , , , , J ✓ ON Piano, S....... Organ, $....... Melodian, S........ therein ON Printed Books, Pictures, Silver and Plate therein, ... ...... Ox........ .. I ON Barn No, I.. :...:: (J!ticta/� ........ x ........ a... . .. x ........ ON Barn No. `? ...............G!j'C...� ! . /.:..... ... ...... ......,x, a. .x. ....... ... .. ........ / ONBarn No. 3 ........................................... ON Barn No. 4.................. .... x........ a........x........ ON Corn Barn or Granary, ... . ON Produce in said Barns and on Premises .................... PRESENT NO. OF ANIMALS. ON.............. ................................... .... Horses, .......... Cattle, ..... ..... ON Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep, ............ Fowls, ............ . in said buildings and on premises,,, , , , , , , , , , , , , , ,,,, I INDIVIDUAL LIMIT ON ON Live Stock ON Horses, $........ Cattle, S..........I Horses, S......... Cattle, $.......... therein to wit: , ON Sheep,.......... Fowls, $........ Sheep, $........... Fowls, S.......... Rate..... ... ..%s- ........... Total, $.,2.� �U. Premium ..? ��............. Situated in the town of.... �G?.Q� .�.... CaN uga County, N. V. I low inany�ryacres of land in the place? ................ What is the value of the land and buildings? $, ,,, , , , , , , , , , , , , , , a )f what material is the house?.,/V�l�2"ow old is it?............ years. How many stories?.. .........For what is it occupied? ...........By whom?..................Is it painted outside?. Inside? ........ In what repair?.......... Is the Ist story plastered?. ...... znd story?, ..... , ,Are the chimneys all of brick? ...... Are they in good condition?..... . How high above the roof is the lowest?.... ft. The pipes are iii good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. Alt wood ashes are kept at least thirty feet from any insured building or in ................................ Barns —Material flow Old Cover of Roof Condition How Finished ,Painted No. I ................... ............ ..... ... .. ....................... ....................I•.. ........................ ...... ........... ......... .............. _ No. 2........................................................................................................................................................................ No. 3.......................................................................................................................................................................... Loss, if any, on buildings, payable to............................................................................................................................ ...........................................................................................................as... .......... ...... .... ...... Interest ...... may appear. Has the Applicant ever had a fire? ......... lf so give origin and explanation .......................................... .. Has the applicant any n 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. 9--Wi ..... ......W�-- ... .. ...........................APPLICANT. THE SOLICITOR WILL PLEASE ANSWER THE FOLLOWING QUESTIONS: THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County APPLICATION OF R. D. /..... .....� County of..,..t-+l.. State of .....r>r',G...nir'. ... ... 1 Townof........ -------- -- o Premium .............................. Vje�v. d Discount for approved Lightning Rods...... ............. $................ Total....................................$..p�t... Date of Risk.. .... , ...J....... 182.y Time..... _; ......years. yl Z i.. /..... . ...........:.. SOLICITOR. 0 Renewal of Polic} No..G...... Reinsured No....... 2-- . 7`", ...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? ........................ ........................................ ... C(1i.iCITn R_ EAST U -00 W F 0 w 0 a F 0 WEST a to t' 1.1pplicatioll of .................. .4rr.' ... ;«t ...f, i ?:Z '1.. R. F. f)., No............ Posto ice....... ........ ............. ........ County of.................................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. Y. for the term of .................. years from the............ day Of.-. ..... .........192 lit, noon, to the...../. ..day of. at noon, .on property located on the.... ..side of ... .............road, .........miles from ............................ .in the Town -of ...�r�,t.:.:1.....County of.... ,f..,:........... .and State of 1 — ew York, as follows Amount IIlsured Ir $••.0.Q.0... On Dwelling House and Attachments ................. On Household Furniture, Printed Booke, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises $...�.�.t .On Piano $ .................On Organ $�................. On Phonograph and Records $.................. Oil .... .................................... $..10.a..... On Barn No. 1 d�..................On Barn No. 2 $ ..................On Barn No. :3 $ • ............... On Barn No. I $.................. On Hog House $ ••• .............On Hen House A IDOU IIti Insured $ ..................On Corn Barn or Granary $ ..................On Produce on Premises �5................. On Farming Utensils, Carriages, Sleigia, Robes, Harness and Automobiles ................On Horses $ ..................On Catt le $ ..............On Registered Cattle $ ..................On Sheep ..................On bowls .................On Swine .................On........................................................ $....... .........(-in ..................................................... $..,jOQ.Q••.'Fotal ............Rate ........... Premium How many acres of land in this place? /xr77"'rWhat is the value of the land and buildings? $./S*.io How many stories in dwelling house?..I. �.L... By whoa► occupied?.C�".,..Ly A Is i ainted outside?. Inside]?... Is the first story plastere�ow .... Second story? .... Are the chimneys all of brick' Are they in good condition ?... *.Sti'......... high above the roof is the lowest ?................feet. The pipes are in good condition safely secured an 4enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at leant thirty feet from any insured building or in.....,a L ............... . Value Material How Old? Cover Roof Condition Painted SIZE OF BUILDINGS ' Height flouee ........:$.............. Barn No. 1. $.............. Barn No. 2.. $.............. Barn No. 3.. $ ........... .................. ............................... ................. ....................... Loss, if any on buildings, payable to...... ........,?', of Posts x........ a ......... x...... ......... x........ .a ......... X . x........ a ....... . X...... ........ x......... a ......... x...... I......... ......... x......... a..... ..x. .................................Mortgagee......, as.... ... interest ...... may appear. What buildings, if any, are equipped with lightning arods?.,�. � Name manufacturer? .............................................................. Date installed?........................... Are a11 ground connections satisfactory ?............ Total insurance on rodded buildings $............... : 25 per cant discount for rodded buildings $.............. Has the Applicant ever had n 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 ?..4Ll'. 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 property? ..-.rLr-,i-j d,�,..... . title or interest in the.... How much is it encumberedY14S,,,,,,,,,,,,, ,,,,, 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. ...`.....fb!?1.!u,. ....��c/ 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 vnn t.hon ► QnPCt. t1,P rhirnnnvc and rhino. whn— +)am.. . .. +r,,., -1 ___.i n_ _-_ -- • `1vr� ��'�'�► �'�'� �► N^V� 1tiK • FARMERS' MUTUAL � INDEMNITY ASSOCIATION P of Cayuga County, Vo. /J;�------ APPLICATION OF ......................................It. D............... .. Countyof ............................................... 0 Stateof ................................................. 0 Townof ......................... ..................... ---------------- Premium.......... ....................�i........... ...... SurveyFee......................... $................. Total..... ..................... ........ $........ ......... Date of Risk ................. .................15)1... Time .......................years. ............................................................ SOLICITOR. Renewal of Policy No ............................ ReinsuredNo ........................................... ........... Age...............years. In what repair ?...... Material of house No. 2....................................... Is it necessary and o remunerative in its present condition ..................... Is it painted? ....................... Is it plastered? Are the stoves, pipes a. y and chimneys in good condition and apparently safe ?.......................... Where and how are ashes kept? ..............• ••••••"•••••""" U r:. .............................................................SOLICITOR. .......... East ° a � m t0 U J F—I N / _ o w •`ll n 00 00 o ce A a :� a be 03 ❑ v � a be m 0 0 0 �, 9D m * yi Zipplication of....,r................................. ........ R. '.F. D. No ............. Pusto(lice.. County of ........... ..............and State of New York, for insurance against loss or damage by fire or lightning in the FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. Y. for the term of ...... ......... years from th .�......... e. .day of ........................ f .. ...at noon, to the...'..s:......day of....... at noon, perty located in the town of........... 19 . on pro ....- -- ..._ -... . ....................................C.ounty of Cayuga and State of New York, as follows: Amount 1'alue of Height Insured Buildings of Posts SIDE OF BUILDINGS On Dwelling Hound and Attachments ...................... $ I Orr Household Furniture, Provisions and Wearing .ing A.........! .............I ............ ......................... x ...........a ...........x ............ pparel I therein and on premises ....................... ...! On Piano, $/.Z.`J. Organ, $........ Melodeon ......... 2 $ therein ..............i On Printed Books, Pictures, Silver and Plate therein........ On OnBarn No. ]............................................................... i On Barn No. 2.................... .............. ..... ....... ..... .......• ............ a............ x ............ n Barn No. 3 ................. ........ ........................................ ............... ....... ....... i.............. ...... .... .x ............ a............ x.......... Orr Barn No. 4............ OnCorn Barn or Granar...:................................................................................. x............ �............ x............ y....................................... I On Produce in said Barns an ....... �............................ ..... .......x ............ a............ x............ d on Premises....... ..........�..! .. .. PPIESENT NO. OF ANIMALS ...................... ...... ...... ............... I....... ....... HorsesCattle............... ......... n Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep ................. Fowls............... in said buildings and on Premises....... .................... *INDIVIDUAL LIMIT ON ............... On Live Stock, On Horses, $......... On Cattle, $ ,% c ,, to�Oji .v. I Horses $ ...............Cattle $............. -wit Sheep,'$ . On Fowls, $......... RateSheep $ ....:.............Fowls ...J . �... $.............. ............. ! I — _.......��......................... Total, Premium ............................ ...... Situated in the town of............ .....Cayuga County, N. Y. How many y 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 ? How mans stories ? ............years. For what is it occupied ?........ By whom ?......... ••••••••• ........ Is it painted outside ?. Irrsicle ? .......... .......... ••••........... 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 ............. ...... a rns— Material. How Old ? Cover of Roof. Condition. How Finished ? Painted. No. I... No. 2... No. 3 .. ..................... Loss, if any on buildings, Payabie to ..................... ....................................................................... .............................................. .. ...... . u . ..... Interest............ may appear. Has the Applicant ever had a fire ?... Lr.... If s:), give origin and explanation .............. special reason to fear fire from incendiarisrn ?....... """"'•'••'•"•••••••• Has the Applicant any .... Is there any other Insurance on this property, or any Other rxposrd with it, in this Company ?............ If so, state amount ......•••••. Name of Insured.. .............. .........No. of Policy Is there any Insurance in any other Company �..,......,., ���� .................. P Y • If so, state amount and what it covers, oil back. What is our title or interest in the property ?............ S .............................................. 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 by any member thereof, during my membership. Given in purpuance of Section 7 of the Act under which the Association isyorgan- zed and in conformity with the By -Laws of the Association. ........................................... , r:... :: .:Z,/., ..,.-' �J. `. The Solicitor will lease answer the following iestions:— Applicant. g Q' p Have you carefully examined the above risk ?........ ` •••• When did you last examine it ?. Ch1% ni.ir.. n..< .,.•.a .__t. _ .. .... ......... ..... ......... Did von then i)1Qnn^P THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County I 'ION O . (.. , 41..... ... . .. ...... R. D.......... ......... Countyof ........................... .................. State of..... ... .... .A ............ . . :..... ...........`...... Town o ------------- Premium........................... $..... ............ SurveyFee ........................... $.................. D C7 Total....................................$.P� .. Date of Risk... .........192). Time........ v ...........years, ............ /R..l! ...�.................... SOLICITOR. Renewal of Policy No.LV J-4- j—...... ReinsuredNo ........................................... 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 ?........................ a 0 U d 0 Gra .......................................................................... SOLICITOR. EAST � o z ISM m ba w, � o ) L � b� .o� v M iipplicationof ...... 41-..4.......... .c.... ....................... .ti............. R. F. D No............. Postoffice............................... County of .......................................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL MEMNITY ASSOCIATION, of Cayuga County, N. 1'. ` for the term of... .\� . ears from the. day of... J:..°k,.' ........... 192J. at noon to the dayof. tf u j at noon, on property located on the...............side of .................. road . .........miles from...................................iti the town of ....................................County of .................................... and State of New York, as follows :— Amount Arnonnt Insured Insured $ .................On Dwelling House and Attachments $.................. Oil Corn Barn or Granary $....../ � J.On Household Furniture, Printed Books, $......... Z..,�On Produce on Premises Pictures, Silver and Plate, Provisions $...... ........... On Farming Utensils, Carriages, Sleighs, and Nearing Apparel on premises. $.... ,/...:L..f .On Piano ; $ ...............Or an Robes, Harness and Automobiles on g � $.............. premises Melodeon. $.................. On Horses $..................On......................................................... $..........Z� On Cattle $ ..................On Barn No. 1 $.................. Registered Cattle $ ..................On Barn No. 2 $.................. Oil Sheep $..................Oti Barn No. 3 $ ..................On Fowls $ ..................On Barn No. 4$.................. On ............... ........................ ................. $ ..................On Hog House$..................On........................ .................................. $ ..................On Hen House $...`�.. �..C.Total ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings ? $..... ........... How many stories in dwelling house? ............ By whom occupied? ...................................................... Is it painted outside? ............ IfIside In what repair ?.................. Is the first story plastered. ?............... Second story ?.................. Are the, chimneys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ? Cover Itoof Condition How Finished Painted SIZE OF BUILDIN(4S Height House ......... 1$............... ............... ................ of Posts BarnNo. 1. '$...................... ................ ................ ....................... ..................------ x------ `t ---- --Y BarnNo. 2..$................................ ................. BarnNo. 3- $ ............................. ................ ................. ..............------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 $........ ..... 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. ............... Noof 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 ? .................................................. flow 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, 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. ................................................................. .Applieant. 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 chimnevs?.................. o THE FARMERS' U T U A L o 0 0 INDEMNITY ASSOCIATION of Cayuga County 0 0 . APPLI TION OF ............. ....... ................ .. ... . ......... ............... R. D....... — County of ...... ;"Z..... ... ................ 0 state of ....... .. .... ........ .................... Town of. ....................... � oPremium ..................... ......... $........ ......... 0 Discount for approved 0 Lightning Rods ..................... $....... Total ............................ ....$••'�-. 0 Date of Risk .. ...... .......A.0..1� Time.........../.............years. 0 5 LICITOR.. Renewal of Policy No. .�5?. f,..,�,�..0........ 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?........................... Z z o o U E-y .............................. SOLICITOR. EAST WEST ton .. ........ ... 1-11. F. D., No............ Postoflio44-_. ........................................... .11 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 ...... ?� ........ years from day of 12Z ]():,0, at noon, to th(o;9 .. 3 ... day of;��� .192.,t�'� ......... ............ At�fA -)n, on property, located on tile ............ side of ............. road . .........miles from .................................... in the Town of .. ...... .........County o ... .... . ... .................road, ...... and State of New York, as follows: — Amount Amount Insured Insured .................. Oil Dwelling House and Attachments $ ................. Oil Corn Barn or Granary ... On Household Furniture, Printed Books, $ .............. Oil Produce on Prernkes Pictures, Silver and Plate, Provisions and Wearing Apparel oil premises On Farming Utensils, Carriages, Sleighs. ------- --- -- .On Piano Robes, Harness and Automobiles .................On Organ ®..On Horses .................. On Phonograph and Records $ ..................On Cattle $ .................On...................................................... $ . .............On Registered Cattle $ ................... Oil Barn No. 1 .......... ....... On Sheep $ .................On Barn No. 2 ................ On Fowls $ ..................On Barn No. 3 ............... On Swine $ ....... ......... On Barn No. 4 $ � ............... Oil............ ..... ................ ..... .......... $ .................. On Hog House $ ...... .........Orr � . ...... .......... .......... ............ ..... $ .................On Hen House .... Tota I ............Rate . ........ Premium How many acres of land in this place?............ What is the Value of the land and buildings? $ ... ........ How 111aliv 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 good condition? ..................... How high above the roof is the lowest?.......... ....... feet. The pipes `a1*.e***i`rl '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 How Old? House ........ $ ............... BarnNo. L.$ .................................. .......... ..... BarnNo. 2..$ .............. .................. .................. Barn -No- 3..$ ................. ................. .................. .................. $ ................. ............... ................. Cover Roof Condition Painted SIZE OF BUILDINGS Height of Posts ................. ........ ........ ........ .............. ......... x ......... a ......... x .............. ................. .................. ....................... .... x ........ a ......... X ...... .................. .................. ............ I ........ ......... x ......... a ......... x ...... .............. .......................... I.. I ..... ........... ......... ......... x ........a..... .. X ..... .............. Loss, if any on buildings, payable to............ ............... .... ................................................................ .... .................................Mortgagee..... . as ......... ...... Interest .... nia-v appear. are equipped What buildings, if aii.v, . with lightning rods?............ ................. ............ Name of manufacturer? .............................. ....... ....................... Date installed ? ......................... Are all ground connections satisfactory ? ............ Total insurance on rodded buildings I$ ............... ; 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 Poliev .................. 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 Illuctl 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,conformitywith the By -Laws of the Association. .... ............................. ..... I .............. A n nliea v f- The Solicitor Will 1516MLI 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 chimnevs? fARMERS' MUTUAL Y ASSOCIATION INDEMNITY f Cayuga Count cr ...:.. nnnoorar• eocoaommooerarar�oaoa�a0000c�oca�aca000n a nnaror aoor�onoaooroo�aoe�maoomo • • • • •�m000000 APP IC ION O ... ... �i R. D.. .. County of.. .. ...... .. ^� State of.. .. •••••• �e Townof ................................ d MAb&y �0000amnoaooeoaee00000ammmoo�o�on°O°°OO°O Sc Premium .. f ............... $ ... ........ of ► 4 i Survey Fee ................ Total.. ............... ..... ........... ooem000000moo�,aooemmmu�mopoc000000000m0000noo Date Risk.. ../ .4' . • • ....191Z Time .... ........ years. A---:1-�s;�X/ . .................. SOLICITOR. n000mmooetmmeoar•�ommeomeeec00000e�am000aomoonr Renewal of Policy No......... . . • Reinsured No ............................. • MAA~AAMAAAA® A ge .... ... years. In what repair ? ................. • • • • . Is it necessary and Material of House No. 2?....•••••••••••••••••••••' 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 ?................ .......... rb, 4 O z East 4seAk W SOLICITOR. 11c a UpoIfcatfon of..... �........................ R. F. D.... .......... . No... . , P, O., . . ................County of.. , , " , , , ... State of New York, for insurance against loss or dam a by Fire or Lightning in the g Farmers' Mutual Indemnity Association,, of Cayuga County, INT. Y., in the sum of Q/ .d... .? ... .............. .............. . _ DOLLARS, for the term of. . . years, to wit. Amount Va'.ue of Height ` Insured Buildings of Posts SIZE OF BUI[.DI\G� On Dwelling House and Attachments..... On Household Furniture, Provisions and Wearing Apparel therein and on premises.... ........ On Piano, S........ Organ, .... ....... . � Q• • �,'' �. .therein , _ • �� On Printed Books, Pictures, Silv.r and Plate therein........ , , , , �( On.... ..................... ... m On Barn No. 1... a.... ........ .... On Barn Na. 2 ...... . ...... a . .......... •. •.. • .. �;_. ...� x ....... x ......... On Barn No. 3....................... .. ... x... ....a........x......... OnBarn No. 4............................ ............... ......... ......x........ a ........ x......... OnCorn Barn or Granary ................... ...... ....... On Produce in said Barns and on Premises. , , , , , , , V . . . . . . On PRESENT NO. OF ANIMALS, .......................... � f i0 • .......... ......... .......... Horses. .. (_rattle, ... .. .. ...... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses �tL—� / 7 Sheep ............. Fowls..` .. , in said buildings and on premises ........ ... . .. . . . . . . . / INDIVIDUAL LIMIT ON On Live Stock On Hcries, $, %} Cattle,, .1D ,i%� , �� Horses .. , , Cattle s, to wit: jj On Sheep, S..... , .... Fowls y... b�n ....... Rate. .. ... ... Sheep $.......... Fowls $.......... ......... ........ Total, .. Premium .. ................... . • y, How man acres of land in the `r- 111 1 Situated in the town of .. N. `.....�"""°.._.°.'..... ... Cayuga Count Y. yplace?../ . . , ........ , What is the value of the land and buildings ? S.. ..... ..... Of what material i"Llln.O.u.s ? Y AA - - -How old is it ?... ......years. How many stories?, ,,1�`L,r, , , ,For what is it occupied?7'11�y �! ..... B whom?.,Y. Is it painted outside. Inside? �!�,�. In what repair ?�-s the 1st story plastered ? . 2nd story?. .j •) N Are the chimneys all of brick Are they in good condition? How high above the roof is the lowest?..'.ft. The pipes are in go-d condition, safely secured an e►�he chimney horizontally by a thimble or are firmly cemented therein. All wood asties are kept at least thirty feet from any insured building or in, . Barns —Material How Old Cover of Roof, Condition, IIow Finished. Painted. No. i ........... .......... No. 2............................................ ................. ............ ...... ............................... ......•................... No: • 3.......... .................................. ......................... ..................................................................................................... ........... ........................ . ........................... ........................ ...:..-, v , ....................... Loss, If any, on buildings, w 1,._ ... .,......:..� :, ..._.. ... ,.. .:............,.... . Ids, Payable to ..... ........ �.G�..... .. ........... ........................ .... ........... .................... a ........................ ••• • Interest : � _ .. ....:. . mayappear. _ Has the Applicant ever had a fire ?..� {�7....If so give origin and explanation..............................................................., ,ca Has the applicant any , special reason to fear fire from incendiarism ?�..,,Is there any other insuranc on t is propertZy'r any other exposed with it, in this Com an ? P Y• • U.........If so, state amount 8.................Name of insured..,,` /` //���� ••••••••••••• •• ...........No, of Policy � ,�,,,Is there any insurance in any other Company?...:L4,.......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 nimed, I do hereby give my Undertaking, executors, administrators and assigns to pay to the said FARMERS' MUTUAL INDEMNITY ASSOIATION, of 1Caynd myself Countyn N, heirs, 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 co iformity with the By -Laws of the Association ................................ ... ..... ..... ..... .........................�'......... ••• •• • • • ••• •••••.•.... APPLICANT. 1'he Solicitor will please answer the follow ing questions: ............................. •'%VAW ♦ ♦ THE FARMERS;MUTUAL0 ♦ 0 $ INDEMNITY ASSOCIATION 'o ♦ 0 00 of Cayuga County '0 0 0 0 IR o._ a_ �--------- - 00 0 0 0 APP ION F 0 ... .. .... ........... 0 ,. R. D. ............. 0 County qf.. ... .. .... d State of. ... ♦ Town of ..... .... Premium........................... $.,............... Survey Fee ........................... $.......... ........ Total....................................$.. q Date of Risl. .......... ,_..192L Time ......... .............years. or .... V........ .. .................. SOLICITOR. Renewal of Policv No ......... P4.41177 .....................0 Reinsured No......r!:�...................... ♦ ♦ Materialof 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?........................ 0 all 0 ..........................................................................SOLICITOR. FAST F"' O z1 ZippliCation of. ............. R. F. D., No ............. Post e..................................... County . - .......A ... ............. and State of New York, for insurance against loss or damage by fire or lightning in E FARMERS' MUTUAL INDEM TY ASSOCIATION, of Cayuga County, . Y. for the term"01--.5... ..... vears from the... :•day .............,...192P at noo �e. �. .day 192 ,�,,� ��,�,, at noon, on property located on the;.•. k ide ...........road, ✓yfniles fro in the town of ... .............J.........County of . •••. • ••....... nd State of New (York, as follows :— Amount Amount Insured Insured I $. ..Q.P. P.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 Wearing Apparel on premises. Robes, Harness and Automobiles on $ ..................On Piano ; $............... Organ ; $.............. premises Melodeon. $ $..................On.......................................................... ............ .On Horses $ ..................On Cattle $.................. On ......................... � ................ `.... .... .. $�D.P..0.On Barn No. 1 $.................. On Registered Cattle $ ..................On Barn No. 2 $.................. On Sheep ....On Barn No. 3 $••••••••••••••••••Oil Fowls $ ..................On Barn No. 4$.................. On ............... ........................ ................. $ ..................On Hog House $.............On......................................................... $ ..................On Hen House $.,...%s.....Total ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $..... ........... How nnany stories in dwelling house ?..e2.-7..-- By whom occupied? ..... ... .1 ./.- ......- ........................ Is it painted outside&A�_.. Inside ? In what repair Y ...... Is the first story plastered?.. Second story? . Are the chimneys el of bri Are they in good condition .. How high above the roof is the lowest ? ...........feet. The pipes are in L good con ttion, 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 from any insured building or in.............................................................. Material - Value How Old Y Cover Uoof Conditiop, Huw Finished Fainted i`d/i . yr BU1LL)11N(J riergin House......... $�r� ................ �G/ ........ ... .... of Posts ------x-a------x----- f Posts Barn N.-1.$�Od�.............. 7? ............:. ? - .... x------a------x-----o-� [�-- BarnNo. 2..$................................ ................. .................. „ ................. ------ x------ a ------ x----- -- BarnNo. 3.. $ ............................. ................ ............... ...................................... ------ x------ a ------ x----- -------- .................. $................ ........................................................................................ ------ x------ a ------- x----- -------- Loss, if any on buildings, payable to------------------------------------------------------------------------------------- --------------------r1ortgagee----, as -------------- interest---- may appear. 1 What buildings, if any, are equipped with lightning rods? ........ ......... Name of manufacturer? ............................................. ........................ ................................./...... Date installed ?.... f :: ............. Are all ground connections satisfactory )...�-J Total insurance on rodded buildings 25 percent discount for rodded buildings $/��..��� . Has the Applicant ever had a fire? ............... If so, give origin and explanation............................................. Has the Applicant any spt•cial 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 ?��_ 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 7 of the Act under which the Association is organ- ized and in conformity with the By -Laws of the Association. .....................................................................Applicant. The Solicitor Nvill 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 pip where they pass through partitions and floors and enter chimneys ?.................. THE FARMERS' MUTUAL 0 0 0 10 INDEMNITY ASSOCIATION 00 0 0 0 0 of Cayuga County Oo 0 0 0 0 moo. a--�----_ 0 A LIC VTION OF 0 .......... 0 IL Loounty or....../... c.... ... ................ 0 State of...^�..���........... Townof............ .. .......................... 0 $ !$ - -, /_ / -�''__ _ ♦ Premium ........................... $..... ............ SurveyFee ............................ $...p.............. Total .................................... $..,(,t`':�:":'"� 0 Dateof RiQ .. ...................... 0 Time ............. .... ... .......years....... 0 0 .... ... 0 0 :�_A(:z �-x A- 0 SOLICITOR. Renewal of Policy 01) Reinsured No.........0)...../., ....... 0 1�✓� O �'A���11 v�� Nam• 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 ZSHAt a 0 a J 0 m w tw O •� U a� U m cd �a c � o o � U C ss: � b y y _> o sk •� m a to cc ..y c h W ro � es o i m .E 4 EppItcattO R. F. D., No............ Postofli . ...... ..... County of.. ...... ... .............. and State ,gf' 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.................years from the..... .....day of ........................ 192... at noon, tote .......... dav of ................... 192... at noon prop rtv located on the E .....side ................road, .�....n►iles fro .......... in the town of v ...........................County of..... .................and State of New York, as follows: -- Amount Amount IDSured 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 Wearing Apparel on premises. Robes, Harness and Automobiles on $ ..................On Piano ; $............... Organ ; $............. premises Melodeon. .On Horses $..................On.............................................. .... $.................. On Cattle $.�..i?,.�!..On......On....................................... ...............,$.. .On Registered Cattle $ Barn No. 1 On Barn No. 2 $ ..................On Fowls $ ..................Oil Barn No. 3 $ ..................On Barn No. 4 j$.................. On ............... ........................ ................. $ ..................On Hog House $..............On......................................................... $ ..................On Hen House $ .................Totall ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $..... ........... How many stories in dwelling house ?..:.. By whom ccupied ? Is it painted outside `? .�� Inside ? In what repair? Is the first story plastered ?.... .. Second story `� . ..per,,.!•.•. Are the chimneys all of brick?. Are they in good ndition ?. How high a ve the roof is the lowest ? .��.�......feet. The pipes are in (.i�� m therein. 11 wood ashes good condition, safely secured and enter the chit ey horiz��ntall_y by a thimble or are firmly cemented the e n A are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height of Posts House....... S$ ................. ................ .................................. ...................------ x------- a ------ x------------ Barn No. 1.4.- .... n! ....1. ....... `... ......... I..... ../...�................ BarnNo. 2.. $.............................. ..........................................................................------ x------ a ------ x------------- BarnNo. 3.. $ ............................ ................ .....................................................------ x------ a ------ x----- - ------ ............ $........... ..... ............... ....... I......... .................. ..... ........ I ......... .................. ------ x------ a ------ x----- -------- Loss, if any on buildings, payable to-------------------------------------------------------------- --------------------flortgagee----, as -------------- Interest---- may appear. What buildings, if any, are equipped with lightning rods?............................................................... Name of manufacturer? ,,.................................i.................. Date installed?........................ Are all ground connections satisfactory?............ 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 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?............ 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. .. s ........... ..........................................Applicant. The Solicitor will please answer the following Questi�rs Have you carefully examined the above risk? .... When did you inspect the risk inside and outside?...... . ................ Did you then inspect the chimneys and pipk where they pass through partitions and floors and enter chimneys? .................. T THE FARMERS' MUTUAL i ASSOCIATIONINDEMNITY, f of Cayuga County APPLICATION OF :...... .... ........ ........ .... ......_.. R. D................... County of........ State of ........ .`�.. Townof.-:....4 .. / .. ....... ............. . i Premium................ ...... :....... $.................. Discount for approved Lightning Rods..... ............h...•//••// Total .... tal. ...7... `rk 0 .............................. ......... Date of PviekL/...".... Time 1 ' .�.t..... .......years. `��' ........ .......... SOLICITOR. Renewal of Policy No..9•11•1•••• .• ' Reinsured No ............ ..`:..:. ...... f 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, pipes and chimneys to good condition and apparently safe ?............... Where and how are ashes kept ?........................ ......SOLICITOR. EAST 0 ° ° # o a� � y O rbf O 0. �z iT, be cc .. 0 -------------- 0 0 - as w » y f1pplicao0ju of.. ... ... . . ... .. . ...... . ........ ........%- L ........ County R. F. D., No............ Postoffice.��..C.7.1�� ..... .. ....... d State of 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.....( ....... years from theCRSE_._ day of ....... 1920 at 110011, to tIjeA�..:dRv i&/ at boon,, oa property. .. located ?n Slue (11 -de of465- Z.. ..... in the, Town of . County of... .. .- . ............. ...... .. ....... ............. and State, of New York, as jollows:— Amouut Insured Dwelling House and Attachments $ "?A ,A� .....On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions stud Weariug Apparel on premises Amount Insured $ .................. On Corn Barn at Granary On Produce on Premises It, V TT Farming Air, Utensils, arr age@, Sleighs, $ On Piano. Robes, Harness and Automobiles $................. . On Organ Horses $ ...... On Phonograph and Records On Cattle $./.V. - 0 On,; 10L-L-0 ........ ............... ..............On Registered Cattle 00 $-00--�...OnM.-.................On Sheep $ .....On Barn No. 2, $ .................. On Fowls ...... On 1 .................On Swirl 4" (ze4F I A ..... On ................. On. ....................... .......... $ ....On Hog House $ . ...................... 9.2.'--On Hen House Tota I ......Rate ........... Premium How ilia4y acres of land in this place What is the value of the land and buildings? $ ... ........ How manv stories' in dwelling house?... .Z . ..... By whom occupied,13 ............. CL_�, "e, .- 1 6 . Or ...... ... . ..................... Is it painted coutaide7 Inside 9. Is the first story plastered' Second story?.Are the chimneys all of brick? 1Z Are the in good condition? ..................... 1�1" y 0 w high above the roof is tweet?..................feet. The pipes are in good condition, safely secured and enter the chininey horizontally by a thimble or are firinly cemented therein. All wood ashen are kept at least thirty feet from any insured building or in............ ........... ........... Value Material How Old? "I Cover Roof' Condition House........ $ ............... ...... .......... ...... ........... Barn No. L.$ ................ ........ i .................. ........ ....... Barn' No. 2..$ .............. .................. .................. .................. ........... BarnNo. 3..$ ................. ................. .................. ................. ................. $... .......... ............... ................. ......... ........ ................. Painted SIZE OF BUI� DINGSj Height of Posts. ...................... X xe, x a ......... x .... ..... ........ .............. ....... .................................... Y..,r= .......... X ...... . ..................... ......... x ......... a ......... x ...... ..... ........ . ..................... ......... x ......... a...., .. X ..... Loss, if any on buildings, payable to ........... . A.... _�- e ..... .......... � ............ .................. ..... ..............................Mortgagee......, as................ interest...... may appear. What buildings, if any, are equipped with lightning rods? .............. Name of manufacturer? . .............................................................. Date installed Are all ground connections r-atisfactory? ............ Total insurance on rodded buildings $ ............... ; 25 percent discount for rodded buildings $.............. Has the Applicantever 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 iL in this Conjpany?-)-�-... If so, state amount $ .............. Name of Insured............... ............................ No. of Policy.................. Is there any other Insurance in any other Corparry ? If so, state amount and what it covers, on back . What is your title or interest in the property?.. . ............... I ..... How much is it encumbered? In Consideration of the Insurance Itained, 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. The Solicitor,will please answer the following Qu ................... . ............ AppliT ant. estions:— _ Have you carefully examined the above risk? ........ ..... When -did you inspect the risk inside and outside?........... I)id you then inspect the chimneys and pipes where they pass through partitions and floors and enter chimnevs?. ..­'.*­­*... THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County Sao. ��iaa AB LICA'F N OF ON OF State of Premium. ................. .. � Discount for approved o Lightning Rods..... .............. ......• ... . Total................................... $..: l� . 0 Date of Risk ........ ................. .u�.......19 Time...... .............years. a............. ..... SOLICITOR. --- - ------ - -- ----- d Renewal of Policy No �.•••••••••••••• •...... -• 0 0. Reinsured No..............Y`?-:. ... 4 Material of house No. 2............................. Age ............years. In what repair? ................................. Is it necessary and o _ m 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? ......................... o ...... .... SOLICITOR. EAST WEST .... ...... 3 x .F O W b c ar 4.11 � m o � ro �. ... b_ ago az � b v m 3pptic 4l t -o'f.. ...... .. �� r2� - R. F. D.• No../.i9'�:,_ P(�gtotfil� ........................... County ..and State of 1\'E:w York, for insurance agtinst loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. for the ,terms of...�...,•,... ears from th y t ��%..... day of..................:.....1 at noon, to the.j....... day ...... 192... at n o ,fm property located on th / ......side 9t.. (,/ ,• .road, ... rniles from ............................(. .....in the Town of County of. ,.and State of New York, as follows :— A mount bnsurod - $�c ....On Dwelling House and Attachments .•••••••......... (fin Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel oil premises -............. .On Piano .................On Organ ................. On Phonograph and Records $.....�j�.�.. .. Op �.�...-�-.. .... ..�LJ/n - Barn No. 1 $....... � 4...On Barn No. $......, v..On Barn No- 3 ....... ....On B*m Ntr:,4 �••••.` ?d...Oil Hog Housei •-•••�...d... On Hen House Arnourit Insured .................. On Corn iiarn or Granary $............... .Oil Produce (m Premises $................. On Farming Utensils, Carriages, Sleighs, Itubes, Harness and Amorr€►obiles $ .................On Horses $ ..................On CatQe $ .............. On Registered Cattle $ ..................On Sheep $ ..................On Fowls $ .................On Swine $ ........t q..Om......................-C..... Total ............Rate ......... Premium How inapy acres of land in this place?............ What is the value of the land and buildings? $........... How many stories in dwelling house? .............. By wham occupied?............. Is it painted outside?.. V............ [['side? .............. Is the first story plastered'?.............. Second story? Are the chimneys all of brief? .............. 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............ i Value Material How Old? i Cover Roof Condition Painted SIZE OF BUILDINGS Height of Posts ............ ;arn No. I.. $...................... ......................i ......... x......... a.........x ..... Fiarn No. 2..$.............. .............. ......................... .........x ........n........ x...... ............. BarnNo. 3..$.................................. ... j.........x......... a ......... x...... .............. ........ $................. ................. .........-........ .................. I ......... x .........a..... .. x ..... Loss, if #ny on buildings, payable to............................................................................................................................... .................................Mortgagee..... , as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods . ..................V1�.. � d— -• .........., ............................. Name of manufacturer! .............................................................. Date .installed ? .... Are all r tin ion s .. _ ...................... g o d onnect' r satisfactory ?............ Total insurance on nodded buildings $/X7_j... ; 25 percent discount for rodded buildings $;�,f..a.. Has the Applicant ever had a fire ?............... If so, give origin and explanation............................................ Has re Applicant t • t} �,ppl' � ,any epee's[ 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 Poliev ......... ........ ..................... 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 FARhIERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga Countv, 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 N'hiCh the Association ie organized and in conformity with the By -Laws of the Association. ............................................................... Applicant. The Solicitor will please answer the following Qtiestions :- 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 thev Daps through narkit.inna anri fln— ­i ,,.,+,... t.:._._..--_o THE FARMERS' MUTUAL V, 0 1 INDEMNITY ASSOCIATION 0 of Cayuga County 0 In 0 q C2 0 A I I OF 0 R. D. ........... 0 . .. ... 0 County off. ... ..... .................. ......... 0 Stateof ......... ..... . .................... Town. .............. I............... ..... $ - --------- 0 Premium............ ..................$......... Discount for approved Lightning Rods...., ............. $................ . Total.... ...... $ ..�......... 1 Date of Risk.. .................... Time......................years. SOLICITOR. Renewal of Policy No.C2-4 ge l• f Reinsured No ............. . ..-. p ?. .. ................... Is it necessary and c Material of house No. 2...........:................. Age............y�ears. In what repair m •. Are the stove°, a remunerative in its present condition ?......•••... ••: Ie it painted ?............... Is it plastered ?............. a Where and }pow are ashes kept .... pipes and chimneys in good condition and apparently safe ?................ .•.. •••••••••••••••• � ..................... SOLICITOR. 3 LAST a 0 wo c z a m w r O13w D �o A z a c � 3 r d ago ca 'b 'r „ Cd d G C b WEST s` County of ................... ...... ...... gild State of New Yo'rk, for insurance against loss or damage by tire or lightning in THE FARMERS' MUTITAL INDEMNIYY ASSOCIATION, of Cayuga County,, N V. for the terra of....:j ........ years from day o .. ......... . ..... j!).) at poon) the9- 2 .. .... day _.)p at DOMon pro erty located on s' e 0 .................. road, ../ .... miles fro� �. ..... ............... . ....hi the, Town of 4 .......County o ...... ...... . ... ....... -:�D-and State of New York, as follows A rnount, Insured Dwelling House and Attachments ........On Household Furniture, Printed Book, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises Amount Insured ..................On Corn Barii or Granary. Produce on Premises ................. On Farming Utensils, Carriages, Sleighs, $ ... .. .On Piano Robes, Harness and Automobiles $ .........On Organ $ ..... ............ On Horses $ ................. On Phonograph and Records $ .................. On Cattle $ .................. On .... ..... ............ .............. *�­ $ � ............. On Registered Cattle Oil Barn No. 01 '00$ ..................On Sheep , ..... Oil Barn No. 2, $ ..................On Fowls $ ..................On Barn No. 3 s/ 2,�iLr�rc ................. . ...............On.Swine.. ?-e .. ....... .........On Barn No. 4 On .. .... .. ... $ 7(_)ii Hog House .. ......... ( $ ........ �?.\..�. On Hen House -b .. Tota I ............Rate _ ... .... Premium How many acres of land in this place?............ What is the value of the land and buildings? $ ... ........ flow many stf)ries in dwelling house? .... By whom occupied9 ....... Is it painted outside*t-.--. . ...... Inside?.... Is the first story pla red Second story? 44­5 -... Are the chimneys all of brick? ................ y pipe are i n good Are they in good condition above the roof is the lowest? .................. feet: The 15 a condition, safely secured first story chimney horizontally by a thimble or are firmly cemented therein. All wood ai,41ws are kept at least thirty feet from any insured building or in .................................... ........... ........... Value Material How Old? Cover Roof Condition Painted SIZE OF BUILDINGS 'Height 3 Of Posts, ............... ..... .......... ...... ........... .................................... _ .................... & , ....... .... BarnNo. I ....... .......... .................. .............................. ......... BarnNo. 2.. .............. .................. .................. ................. . ...... ..... ....... BarnNo. 3.. ................ ................. .................. .................. .................. ..................... X a .................$..V .............. .............. .. ......... ........ .................. ................... . ......... x .... a ..... X ..... ............. Loss, if any on buildings, payable to ................ . . ............ ........................ ................................. Mortgagee...... , as . . ....... Interest...... may appear. What buildings-,, if any, are equipped with lightning rods? ...... Name of manufacturer? - I ........... ............ .............................................................. Date installed ? .......................... Are all grmind connections satisfactory ? ............ Total insurance on rodded buildings $ ............... ; 25 per cent discount for rodded building~ $ .............. 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 ainount, $ .............. Name of,Insured ......................... .................. No. of Policy .................. 19 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 inuen 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., rev 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:— Ifave 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 vartitions and fln,­­ -­l THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County 10 0 1RO., APP ICATION RF County of.. �11. ...... Stateof .; ........ .............. ................ Town of...... ' .....r ........................ -- -- ------------ Premium:............................ $1. - � 0 Discount. for approved Lightning Rudy .... ............. ........... . Total.................................. $�.� Date t;f Risk.( ..AL ........... 192.7!"0 Thne... ...mars. ' SOLICITOR. p Renewal of Policy No....�. 0 Z _v Reinsured No .......... `,Z. E�..� (r;, •V V Oft r�•11��N�1�A ��1�10 Material of house No. 2............ ............... Age ............ Year s. In what repair ?................................ Is it necessary and c 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 flow are ashes kept? ......... .......... a U ........................................ ... ............................SOLICITOR. A is EAST 0 bz o 0 - wrk H AI Vol c., U tp a ci d 0 0 0 b ,� Es", 11 c :D Wheatton of:i�.�''✓t.�.eil....� �::lk G..... ..:... R. F. D.o , N............ Pestoflice....� .`.................... ........ Ccnnnty o .. ........ slid State of New York, for insurance against loss or damage by fire or lightning ill TN FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the term of.....L. ........years from the. Cu. day of...........192lf; at, noon, to �-....day of.. ..........•..192.. `7 at noon, oil property located on the.4. U.' .....side of ........ i.....� lfc .miles from.. r!(�!wc ....J.. ..... the Town f ' .....and State of New York, as follows :-- f Amount A rnou rat Insured Insured $ ..................On Dwelling House and Attachments $ ..................On Corn Barn or Granary $ ..• ..............On Household Furniture, Printed Books, - $ % t)n Prodnce on Pren►iees Pictures, Silver and Plate, Provisions ••' and Wearing Apparel on premises $... �............ On Farming Utensils, Carriages, 4lc>ighs, $ .............. . Oil Piano Robes, Harness and Automobiles $ .................On Organ $.................. On Horses $................. On Phonograph and Records sir-u!u $.................. On Cattle $4�h!...Q....On.�.t.r......'L $ .............On Registered Cattle $.e.Q.J...�.? .On Barn No. 1 $ ..................On Sheep $ .................On Barn No. 2 $.................. On Fowls $ ..................On Barn No. 3 $ .................On Swine $ ... ,. $ ................On Barn No. 4 .................On..... $ ..................On Hog House $...... .........On ....................................................... $ .................On Hen House �� Total Rate Premium How wany acres of land in this place?............ What is the value of the land and buildings? $........... How inane 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 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? Cover Roof Condition Painted I SIZE OF BUILDINGS Height of Posts 13c;IIse ........ $............... ....................................................... .....................�........x......_..a.........x...... 1' ............ Barn No. I_$..............................................................................�': �. .�.1%x...�,? ..........x ... � 1!c...... BarnNo. 2..$.............. .................. .................. .................. :..1'2 c: t 9-:`.................i .........x ........a........ x...... ............. BarryNo. 3. $........................................................................ .ljo. '..... I ......... x.........a......... x...... .............. ......... ........ $................. ............... ................. ......... ........ .............. f . ..................... ! ......... x ........ a..... .. x ..... (.............. Loss. it any on buildings, payable to............................................................................................................................... .................................Mortgagee......, as................ Interest...... may appear. What buildings, if any, are equipped with lightning rods?.....:,:.. .: ..1. .�:t L :�k�.�::./ti.... Name of manufacturer? ...................................... I....................... Date installed ?........................... Are all ground connections satisfactory ?...... ..C� e__ Total insurance on rodded buildings $... ; 25 per cent discount for rodded buildings $.a...`'.U... Has t>re Applicant` 'ever had a fire? ............... If so, give origin and explanation............................................. Has; the Applicant anv 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 Poliov......... . Is there riny other Insurance in any other Company T jam 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 Caynga 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 inspect the risk inside and outside?.......... ...... ,!. o THE FARMERS' MUTUAL 0 INDEMNITY ASSOCIATION 0 Of Cayuga County 0 Vo. c - - - f APPLICATION OF !/ ✓� ................ .. 0 ...... ...... ... R. D................... .� County of...: ` : ,.... State of .... ...... (.►....�J..�....................... Town of.....^..C.'!�- ...... ..... I'remiu�:�....... Discount for approved Lightning Rods.. .......... $. ..... ...:.. �, Total................................... Tate of Risk (��-'Vl:,...??Z:�. Thile..... ........ ._....... years. " ...............l..l- SOLICITOR. Renewal of Policy No..P.t./.A... �./..... . 0 Reinsured No........'�i. ��-�.. . ...... 0 Material of house No. 2............. ....... I....... Age ............ 3 ears. , In what repair ?.......................,........ Is it necessary and c 0 remunerative in its resent condition ?.............. p Is it painted? ............... .. Is it plastered ?:.,..;,.,.,..,.. Are the stoves, pipes and chimneys in good condition and apparently safe ?.............. W, ere and how are ashes kept? .......... ............... � ............................................. ..... ....................SOLICITOR. 3 EAST U 3 ro p o c " . o rr a z ZAC o U v � C 0 0 0 m a f - a �lp��lfcatiott of...�� h��� ...................�� ... ...... R. F. D., No............ Pest„rfice......��%..� :c� rv�?. ........ 0)nnty of.................................and State of New York, for insurance against loss or damage by fire or lightning iti THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the terin of .)..,......pars from th//e....�..(o. day of .6 ............192.�.., at noon, to the.`..........day of.Lk- ._l....... 192... at noon, on property located on the..)l.Q:....side of. .....road, ./..... miles .. d�...�...in the Town of Y.l.,.......Cuunty off: ......and State of New York, as folfo,ws .-- 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 r I;. On... :. ..................On Barn No. I ..l: l�..�'....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 mi Premises t$<................. On Farming Utensils, Carriages, Sleighii, Robes, Harness and Automobiles $ .................On Horses $ ..................On Cagle $ ..............On Registered Cattle $ ...................On Sheep $ ..................On Fowls OXX Ott .°?� :!�#:. y'c, i!;� 1' t t-7 �, ../. .. ...... 4. 7. ..................... .. Totai ...........Rate .......... premium How many acres of land in this place?............ What is the value of the land and buildings? $........... How mane stories in dwelling house?.............. By whore occupied?..( ................................ Is it painted outside?..r. > Inside?.4-�U�j.... Is the first story plastered?:... Second story?...'!.. Are the chimneys all of brick? . Are they in good condition?... .S.E�...... 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 ashe:+ 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 lI �6 Dose ....... .X-�. �% :1..::. ..... ........................... 'i :... ,� .: ...... .I;�t� ........ x ......... a......... x ..... . . Barn i� 1 o. I. $................... ............................;:..................................................... .........x......... a......... x .... .............. Rain No. ............ ............................( /� ` �. ; x �.. a. x I . BarnNo. 3.. $...................................................................................... .............................. x......... a ......... x...... I ............ .........i................................ ........................................................................ ......... 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 .....'.'�:..... `.:`. T.... Marne of in, nnfacturer? .............................. . ........................ I...... Date installed?........................... Are all ground connections satisfactory ?. Total insurance on rodded buildings °.....:.s�.Y .. �%; 25 percent discount for rodded buildings Has t1,e Applicant ever had a fire?..... eAr-V: 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 Cornpanv?............ If so, state amount $.............. Name of Insured........................................... No. of Poliev ......... ........ Is there any other Insurance in any other Company?.4"6 e� If so, state atnount 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 Undertalring, 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 Lightning, sustained by ;iny member thereof, during my membership. Given in pursuance of Section 7 of the Act ender 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?....r:.:`...... When did you inspect the risk inside and outside? ..��... THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County io. _ -o--- - - APPLICATION OF . .... . /!!..Gb ...... R. D........... County of.,.L State of ......... .... ....:... ,.�l........... Town of....... ��...'.:4?........ 0 i 9 i/ Premium ............ ................ $................. 1 Discount for approved Lightning Rods .... ............. $............... . eTotal .................................... ................... . ..........19.2..� . Date of Risk.. ..6... ` Tine., .......Fears: SOLICITOR. � Renewal of Policy No.....1 t/�• Reinsured No......... ...... Material of house No. 2............ Age............N ears. In what repair? ................................ Is i necessary and t ry o 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? ........................ c U -. - .......................................... ... ......... ...................SOLICITOR. EAST a to r � � i=+ n O o b • � b �e a � R c application of.....�... ,0... ,.IJ.. �:!. ........ /.c 1, ................... R. F . D. , No............ Postpflice...... county of.,.:-, ...:,,;�,oand State of New York, for insurance; against loss or damage by fire or lightning ir, THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of ...: .­)......... vears from the. �..i�.• day of........ ...! 2► 4 at noon, to the...` ,day of...0 at noon, on property %v 'yjil p perty located on thc,..,,...lr...side of..................road, :.. c, miles from...........` t .r,ti/...in the Town of Y...�...J:::..: .....County of` ..LL9 ?re-t-�c;-7.r��. %.t.. � 7• .and State of New York, as f0�lluw4:_ - Amount Insured •........... J.... On Dwelling House and Attachments ................. On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises .............. .On Piano Arnourit Insured $ ..................On Corn 11arn or Granary .,::....-::.t:....On Produce on Premises �� ziJl/an.lJ .•......•........ On Farming Utensils, Carriages, gleighe, Robes, Harness and Autornobiles .................On Organ $ ..... ............. On Horses ................. On Phonograph and Records $ .................. On Cattle $.................. i.l.:..^...> On .... .......................... $ ..............On Registered Cattle ...... On Barn No. 1 G�,���'v...C-B�'at'-'G�i,�'L�/, $ ..................Orr Sheep $.................. On Barn No. 2 ,'$ ..................On Fow19 ........On Barn No. 3 $ .................On Swine $ ................On Barn No. 4 $ .................On........................................ .... ................. Hog House ... .................On Hen House.:�?..4?.J..Total Rate Premium How many acres of land in this place?............ What is the valrie of the land and buildings? How many stories. ............................................ in dwelling house? .............. By who►n 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 tile. chimney horizontally by a thimble or are firmly cemented therein. All wood asheq are kept at least thirty feet from any insured building or in .................... Value Material How Old? Cover Roof Condition Painted SIZE OF BUILDINGS Height Houmm ........ $............... ..... of Posts ................................................ ...................... x........ .a ......... x...... Bsirn No. L. $...... ........ ......... x......... a ......... x Barn No. 2..$.............. .................. .................. .................. .................. ....................... j x........ a........ s...... ............. Barn No. a.. $ ................ ...................................... (......... x....... a..... ..x..... ,.............. Loss, it any on buildings, payable to ................... ......................................... ................................. Mortgagee ...... , as................ Interest...... may appear. What buildings, if any, are egnipped with lightning rods? .................... Name of manufacturer? ................................. . .............................................................. Date installed ?........................... Are all groan connec d bons sat-isfactory ............. Total insurance on rodded buildings $............... : 25 percent discount for rodded buildings $.............. .Has tLe Applicant ever 1:ad a fire?............... If so, give origin and explanation......... e ................a Has the 1 _ 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............ Is there arty other Insurance in any other Company ?......... If so, state amount and what it covers on hack. What is vour title or interest in the property ? ................................•, .... How much is it encumbered? In Consideratiorn of the Insurance obtained on property named, I do hereby give my Undertak-ii1g, whereby I bind nr•yuelf 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 losye9 by Fire or Lightning, sustained by any inernber thereof, during my membership. (liven in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ............................................................. Appiitvant. The Solicitor will please answer the l0llo-wing Qnestiorrs:— Have you carefully examined the above risk?.............. When did you inspect the risk inside, and outside?.......... t FARMERS' MUTUAL P INDEMNITY ASSOCIATION of Cayuga Countyl 1RO V-------- A PPLICA' ION OF ............................. *::......:r R. D...... t:... ... . e .�.�. ..... County of..............1. .... ............ Stateof ................. ......,.................. P Town of ......................... ............::�..... / 43 ..__-------- PPremium ............................. ........... P SurveyFee.......................... ................. Total..................................... Date of Risk ... r..:" c..4.�.......l�l: P Time ...... ...... .... ears. SOLICITOR. , Renewal of Policy No .............. ......... 4 r Reinsured No...••• i` Is it necessary an Material of house No. 2........................... .... Age ............... years. In what repair ? ...... ................... a 0 remunerative in its present condition ?.................... Is it painted ?....................... Is it plastered? Are the stoves, pipes O c� and chimneys in good condition and apparently safe ? ............. Where and how are ashes kept ?.................................. ;c ............................................. SOLICITOR. 3 r. i� H A 0 z East °�gah'1 0 b eo b o � 0 co � b W � � W R o b W o ro i p a� c a � � �bd m It. F. D. No ............. Po�qto th (�e ..... . Zipplication of ............. ....... Countyof ............................................ ......and St,,$q of New York, for.instirance against loss or damage by fire or lightning in the FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of ... vmJ/ .......191..at the..vjd. ...ears fothe.dyfX 7.....y... at noon, on property located in the town of ......................i 11tv . ..Con . of Cayuga and State of New York, Amount \,,'line of Height Insured I Buildings of Posts SIZE OF BUILDINGS On Fh\el1iiig House and Attachments ............................. ... $ ............. x a x On Household Furniture, Provisions and Wearing Apparel therein and on premises ..................... ....... ........... 1. On Piano, $ ......... Organ, Melodeon, $ ......... therein ......4 .. ... - On Printed Books, Pictures, Silv(r and Plate therein........ On OnBarn No. I ............................................................... ........ On Barn No. 2 On Barn No. 3 ..... .... . x ..... ...... a ............ x .......... OnBarn No. 4 ............ ................ .... ............................. ............... On Corn Barn or Granary ......................................... ...... ...... x............ a ............ x ............ On Produce in said Barns and on Premises ......................... PRESENT NO. OF ANINIALS, On......................... .. . ......................... ..... /Ie? ... ............... ....... ....... Horses ..... 6 ...... Cattle..-__�z ...... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses ee . ......... Fowls.... in said buildings and on Premises ............... ,?—b ........... 0 INDIVIDUAL LIMIT ON On Live Stock, On Horses, Sj�On Cattle, ��q- Horses $ ...............Cattle $ .. ............ to -wit fOn Sheep, $16_ On Fowls, Jig .. ...... A.e. ghee $ ..................Fowls $ .............. _-el Rate ....................... 6 ............................ Total, I Premium ............... .................. Altuated in the town of ...Cayuga Coulity, N. Y. How many acres of land in this place ? ........ 6 ... What is the value of the land and buildings ? $ ........... 6 ..... 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 ? ........... 6 ...... 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. I ................... ......................................... . No. 2 .............................................. ................ No- 2 ............................. .. ............. ....... . ....... ................. ......................... .......................... ....... .............. ........ ........ ......... Loss, if any on buildings, Payable to ..................... .................... ............................................................... ................... .........................! ................................... ....... ....... ................. as ........... ...... ............ Interest ............ may -In _-pear. Has the Applicant ever had a fire ? .............. If so, give origin and explanation ....................................... Has the Applicant any special reason to feaX fire from incendiarisin ? ............ 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, ***o'*n*"b'a**c'k** interest in the property ? ............. ................... .......... .............. . What is your title or How much is it encumbered ? $ ................ ... .................. In Consideration of the Insurance obtained on property named, 1 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 purpuance of Section 7 of the Act tinder- which the Association is organ - zed and in conformity with the By -Laws of the Association. ..................................... ......... ......... Applicant. The Solicitor will please answer the following Qiiestions:— Have you carefully examined the above risk ? ............ When did you last examine it ? ................. .........Did you then inspect the nhirnnax7a and FARMERS' MUTUAL P INDEMNITY ASSOCIATION of Cayuga County, lRo.- /--_p1 - ------ ----- A PP ICA TION OF %......-c..?. ,................ ........ ................:......R. D............... .. Countyof ............................................. State of...........1.. ...................... Townof ......................... ..................... 0 ♦ --- �- -�-- ----- Premium.............................$...,.,1. �.... 0 Survey Fee .......................... $......�.>.... Total..... ..................... ........ $.... ........ Date of Risk...... .. .......l A l9 . Time ......... 1...7............ years. i SOLICITOR. Renewal of Policy No ...... ............. Reinsured No................�r...e............. iO��01'Nti�1�N��Nrr.11ti�1 • Material of house No. 2................................ Age ............... years. In what repair ?........ ................. Is it necessary and � a remunerative in its present condition ?.................... Is it painted ?....................... Is it plastered? Are the stoves, pipes L and chimneys in good condition and apparently safe 9.......................... Where and how are ashes kept ?.................................. a f-7 � z J� 7 H .A U ......................................................................... SOLICITOR. 3 East o b b0 C o„ �Q C3 U 3 a. � b a� y s� c w b Ce v � a a� o UJ y � v � a Ce be W a F Eppttcattm of.Z..X-e,.'.�.�x�-- R. F. D. No ............. Postutlice.. . ..... .....�., Comity and State of New York, for insurance against loss or damage by fire or lightning in the f�AR15�ERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of...... ..13... years from the..... .1...day of... / <........ 191 7.at noon, to the .... z.7...day of...., /: ljr-.'!rJ-....191.?- at noon, on property located in the town of...... :. ........................ of Cayuga and State of New York, as follows: Amount I Value of Height SIZE OF BUILDINGS Insured Buildings of Posts On D%%elling House and Attachments ............................... $ ............ $............. ......................... x ...........a ...........x ............ On Household Furniture, Provisions and AVea►•ing Apparel therein and on premises ................................................ I I Z I On Piano, $k;?-:A Organ, $....... Melodeon, $......... therein .... ••••.. On Printed Books, Pictures, Silver and Plate therein ......... ............... Oil ................................................................. ............... ............... I............... ............... � OnBarn No. l................................................................ .............. ............... '...... ....... ......x ............ a............ x............ i OilBarn No. 2............................................................................................. .......... a ............ a............ x............ OnBarn No. 3.......................................................................................................... .........x ............ a............ x.......... OilBarn No. 4........................................................................... ... ......................., ............x ............ a ..... . x . On Corn Barn or Granary .................................. ..... ............ I O+oduce in said Barns and oil Premises ............................2. .... PRESENT NO. OF ANIMALS OnZ................................................. ........................... ............ I............... I....... ....... Horses............... Cattle............... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep ................. Fowls............... in said buildings and on Premises ............................ % .. a i INDIVIDUAL LIMIT ON , �°� On Cattle, $.. •,,....,,..D..� How. $.. Cattle On Live Stuck Oil Horses • ......... � 'S � yes ............. . $............. to -wit : �On'Sheep,$........ On Fowls ,4hee ...................Fowls $.......... Rate ._......,_................................... Total, - r `�-5 _� Premium .��. c7............ ...... Situated in the town of.....�.. �u........... 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. How many stories ?............ For what is it occupied ?................. By whom ?........................... Is it painted outside ? Inside 9............... 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 Fi nished ? Painted. No. I...................................................................... I........................ . ..... I ................................................................... No. 2.............................................. .... .................. ...... ................. ......................... .............................. .................. No. 3...................................................................................................................................................... ....... ........ ................................................. ...... ................. ........................................................... ........... 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 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 ?............ 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, wlwreby 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 ►ne►nber•thereof, during my membership. Given in pursuance of Section 7 of the Act under whivii the Association is organ - zed and in conformity with the By -Laws of the Assoc i 'on. ,... ` .. .. LOn. ..... 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 N�1411i.1111�0 f✓q&,jW11W1'!Aq► 0 THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of -Cayuga County °R®.- - AP LIC ION OF X77 / ... R. D.. .......... 0 Countyof..... ........................................ 0 .............. State of .... ....... '0 Town of. Pl e m iu m .......... Discount for approved Light-ning Rods...., .............. $................ . Total................................... $.` .<.. ...... Date of Risk ... ............'.....1p24` Time ...................... years. ....:..... .`.... .. .. .. ............ ...... 'SOLICITOR. Renewal of Poliev No.......! 1��...... Reinsured No.......... �...... ...... •e^vft 1�►���mulls�.�• Material of house No. 2............ ................ Age ............ Years. In what repair? ........... ..................... Is it necessary and 2- 0 m 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. a EAST 0 c • CL nL a 3 � p. • WD as o WEST ipplicarioll ;.......� ................... R. F. D., No.Z.7.... Postoflice �.. ................... ....... County ofZ.t.-....-4— ...................ind State of New York, for insurance against loss or drainage by fine or lightning in TII FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the term of.....J....... years from the... .... day ........... i92'./-,at- noon, to the.... ...day o ....15)L at, non, .on property located .on the ........side o................. ......................................... c Y , -�• � .mad, .miles frr�rn. .in the Town of .County Rf' ... F ������•• ••••"��':.�...... and State of New York, as folinws :— A mount A rnou nt Insured Insured $.................. On Dwelling House and Attachments Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises $............... .On Piano $ ..... ........On Organ ................. On Phonograph and Records $..................On........................................ ..................On Barn No. 1 $.................. On Barn No. 2 $ ..................On Barn No. 3 $ ................On Barn No. 1 $.................. On Hog House .................On Hen House $ ..................On Cora barn or Granary $....()n Produce on Premises ... On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles °...1. �...�....On Horses a On Cattle $ . .............On Registered Cattle $ ..................On Sheep $........ 1%":,:... On Fowls .....On Swine $ ................. O n........................................ ..... ........., $....... .........On ...................... ..... ....................... _.. pp�� .51. .eazr.�.TotaI ............ Rate ......... Premium How many acres of land in this place?............ What is the value of the lend and buildings? $........... How many stories in d"elling house? .............. By whoin 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 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 I SIZE OF Bt1ILDINGS Height Hc,use ........ $ ................ of Posts BarnNo. 1..$................................................... ................. ........ ....... ......... .............. I ........ BarnNo. 2.. $............................................................................ ..... ........ ` x . a. r i. .i .........x ........ a........ x...... i............. BarnNo. 3.. $..................................................................... x......... a ......... x...... 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?................................................................. Name of manufacturer? .............................................................. Date installed ?........................... Are all ground connections satisfactory ?............ Total insurance on rodded buildings $............... : 25 percent discount for rodded buildings $.............. Has tie 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 Poliev.................. 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 i of the Act tender 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? ......... I ................ THE FARMERS' MUTUAL INDEMNITY ASSOCIATION 0 0 of Cayuga County '.A.PPLI� C^—AI.O.....O..F........01.�c..F ram....... . R . D.b!� County of.'`' ""�`+ `/I.{� 0 State of............ i Town of ..... CJ ............. �— — ----- s Premium.............................'7...,. Discount for approved 4 Lightning Rods ..................... $....... i Total................................... :. A Date of Risk ... .... ......1.11 ........ 192il 0 Time........................years. 0 ... �... ......:�.�..... SOLICITOR. r Renewal of Policy No...�.%�f Reinsured IV'o........�s- ..4:.:. ........... 0 i 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?........................... z Q o o c z oG c x O a zz o 4 A . U 4 a � a c o 0 c ................ I ........................................................ SOLICITOR. EAST WEST i� zlppliCatio Of, �!7.I... ..AAJ'� .. R. F. D. No ... �.1.�. Postoflyce...... n.. ..'...`� .�...... County of � �f� j d State of New York, for insurance against loss or damage by fire or lightning in Tl� FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. Y. for the term of....�.......... years from the.... (... day of .......192.� at noon, ;tot e.�.�l....day of19'2� at noon, on property located on thI-r-Alk ide of ..................road, ... ....rniles from. .. .......... the Town of � 'K••�!K:�i 7............ County of.o 7�4. .......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 +........ 5 U ...On Phonograph and Records $... ..........Orr .... ................. .......................... $... 7..e. P... Oil Barn No. 1 e - ...On Barn No, 2 $ ..................Orr Barn No. 3 $ ................On Barn No. 1 $ .......A......On Hog House l..a... Oil Hen House Arnount Insured $ .................On Corn Barn or Granary $.............. .On Produce on Premises $..1.....�i'.. On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles L� .... ,S..O..On Horses $...�..Q.... On Cattle .............On Registered Cattle ................On Sheep ...............On Fowls ,;; ...............On Swine ................On ........................................ ._...... .... ...On ................... I .... ........ ............ .... $-,t( . ..Total .... -�fi--. iatey .. Premittm How many acres of land in this place?.&.4 ...Y.- What is the value of the land and buildings? $........ How many stories / �%. C/. 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? ... `f ..........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? I Cover Roof Condition Painted SIZE OF BUILDINGS Height House ........ $............... ...... .......................... of Posts BarnNo. L.$.................................. ..... x a x i........... ......... ......... ......... ..... .............. Barn No. 2.. $.............. .................. ..... x a x BarnNo. 3.. $.................................................................. Y a x ..................$................................ ...................................................... ......x ........ a..... .x. ... .............. Loss, if any on buildings, payable to ................. 4 r.�-..... ��'.�..u! . .................................Mortgagee..... , asod�... 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 thi9 Company ?............ If so, state amount $.............. Name of Insured........................................... No. of Poliev.................. Is there any other Insurance in any other Comp y?......... If so, state amount and what it covers, on back. What is your title or interest in the property ?.......�� ..... How much is it encumbered? ... /,.; . U In Consideration of the Insurance obtained on property named, I do hereby give my Undertaking, whereby I bind myself and my heirs, executors, administrators and assins to pay to the said FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y., my pro rata share of all liabilities incurred by the Association, and all losses by Fire or Lightning, sustained by any member thereof, during my membership. Given in pursuance of Section 7 of the Act under which the Association is organized and in conformity with the By -Laws of the Association. ........ _ ... pplicant. The Solicitor will please answer the Following_ Questions: — Have you carefully examined the above risk? .............. When 'did You inspect the risk inside and outside?.......................... Did you then inspect the chimney' and pipes where they pass through partitions and floors and enter chimneys? .................. THE FARMERS' MUTUAL S INDEMNITY ASSOCIATION g of Cayuga County. T APPMCATIO OF/ ...... ........................ ...' ....... R. D................. Countyof..... ...................................... State of ......... ....... Townof.......` .................................. 1ft _ U Premium ......................... .....$.................... Discount for approved d Lightning Rods..... .............. $......... . Total ................................... $. , U:..�. 0 _r 0 Date of Risk .:.. ............... 7�7........ lAl Time.......... 0 .� ......years. 0 SOLICITOR. 0 0 Renewal of Policy No ............................... Reinsured No ................................ ...... 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, sL pipes and chimneys in good condition aiid apparently safe ?.................... Where and how are ashes kept ?........................ U .................................. ... ............................SOLICITOR. is EAST G y yJ Z dl : ai U G c x or y O o � R" r - U W aA � G p G b c WEST 'Ei,pplicatioll lit... ::.. :?- It. F. D., No............ Postoflice. ... ....... County of.................................rrid State• of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL 1NDE�MNIT�A_SSOCIATION, of Cayuga County, N. ,�_ for the t rn� i,}`...... years from t:he......... day of ..,..... �E►>,� at noon, to the�...... day of .... l9'?. . at nti tYtr . ro etc laCa4ed on the side.(.f ................-............ .... of �C/� p road, miles from. in the Town t,r Cyy,unty of... . ....�.. ...,. .• _......and State �7f New fork, as follows : ­ A rnoutit; Anroarit I n 4 u fV.d i mu i rca ri .......(fin Dwelling House and Attachments $ ..................On Corn barn or CirarrArlr ��....� On Household Furniture, Printed Books ' ................ .On 'induce on Premises Pictures, Silver and Plate, Provisions and Nearing Apparel ore premises ................. On Farming Utensils, Carriages, Sleigha, $ ............. .On Piano Robes, Harness and Automobiles $ .................On Organ $..... ............Oil Horsem ....... On Phonograph and Records $ ..................On Cattle $ ..........:.......On.... ................................... $ ...............On Registered Cutth- >�.................0❑ BHrn No. 1 $.................. On Sheep $.,­,. ........... On Barn No. 2 $.................. On Fowls $ .:................On Barn No. 3 $ .................On Swine $ ................On Barn No. 4 $.................On......................................................... $............ ....... On Hog House $....... .........Orr ...................... ............................... .........:.:.....On Hen House $ ..D..TotaI ............Rate ........... Premium How inatiy acres of land in this place?............ What is the value of the land and buildings? $........... How many stories in dwellitrg house? .............. By whom occupied?.................. In it painted outside? ............... Ineidet?..:........... 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 pip:-s are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood atthes 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....... $............... ................................................................... ..................... ........x........ a.........x...... Bi;rn No. L.$.............................................. .......................... .............................. ......... x.........a.........x ..... BarnNo. 2.. $............................................................................................................ I ............ BarnNo. 3.. $...................................................................................... ..................... x.........a.........x...... � ............. i ^..............$................................ ........................................................................ .........x ........ a..... x ..... j.............. loss, if any 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 connections satisfactory ?............ total instirance on rodded buildings $............... : 25 percent discount for rodded buildings $.............. Has the Applicant ever hats a firs' ?............... 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 Policv......... ........ 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 Tnsarance 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, A. 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. ............. ...................... ............. 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?.......................... Ilid you then inspect the chimneys and pipes where they pass through t7artitions and Boors and enter chirr►nevs? — _ � ��7r-ems �s •ti�•����+s-� s THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County APPLI ATION OF ..... R. .................. County o .. State of ..... .. ... ............. . .. ¢ Town of.... ... Premiun)............................. $................ Discount for approved Lightning Rods ..... ...........$..... Total.................................. $... 3 ... ! Date of Risk:.. ...........192.Y Time ........ ........ ...... years. ............ `.'fir ....... ........... . SOLICITOR. 0 Renewal of Policy No.. J�..�?'..... Reinsured No ............................... 4 Material of house No. 2............................. Age...... years. In what repair? .............. Is it necessary and c ..... ....... O remunerative in its resent condition ?.......... E p ..... Is it fainted ................ .. Is it plastered ?............... Are the stoves, m a' pipes and chimneys in good condition and apparently safe 7.................... Where and how are ashes kept ?........................ � t`hhf F U1 O H P U ............................................ ............................SOLICITOR. a EAST 0 c ea -d a v H � y � c G 0 > G � y a a v� t o ae 5 c 0 WEST ........ It. F. D.. N o ............ . Postotfice ...... RppticaUon of... County 0 ­ f ......... 47:-�and State of New York, for insurance against loss or damage by fire or lightning in TIC =ARMERS9 MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. Y. for the terns of .... ........... years from the.4:L day of ....... 1192.� at, 110011, to tlle.4..3..day at noon, oil property located on the ...... si d e 0�___ .............road, ......... miles from .............................. ..... i,.rl the Town of ....... ......... cou1tv ref. ... ..... nd State of New York, as follows A mount Amount Insured Insured .................. On Dwelling House and Attachments 4 $ .................. Oil Corn Barn or (31ranary ... On Household Furniture, Printed Books, .................. Oil Produce on Premig", Pictures, Silver arid Plate, Provisions I and Wearing Apparel on premises r... 0.. - 0 n Farming Utensils, Carriages, Sleighs, $ .............. On Piano Robes, llarness and Automobiles $ .................On Organ 0..On Horses $ ................. On Phonograph and Records $ .................. )n Cattle $ ..................On.... .................................... $ . ............. Oil Registered Cattle ..................On Barn No. 1 $ .................. Oil Sheep $... ...... On Barn No. 2 $ .................. Oil Fowls ..................On Barn No. 3 $ .................On Swine ....... ......... On Barn No. 4 $ ................. On ........................ . .............. ...... .......... $ ......On Hog House $ ....... .........Orr ... .................. ..... ..................... .. $ .................On Hen House ... Total ............ Rate ........... Premium How many acres of land in this place?............ What is the value of the land and buildings? $............ flow maliv stories in dwelling house? .............. By whom occupied?.................. .............. .................... Is it painted outside?............... Inside? .............. Is the first story plastered? ......... ..... Second story?............... Are the chimneys all of brick ? ........ ........ Are they in good condition? ..................... flow high above the roof is the lowest? .................. feet. The pipes are in good condition, safely secured and enter the chininey horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in .................................... ........... ... . .... Value Material How Old? Cover Roof Condition Painted SIZE OF BUILDINGS Height I of Posts House....... ........ ....... ...... .......... ...... .......... .................. .................. ...................... i ........ x ......... a ......... x ...... ....... ..... BarnNo. I.-$ ................ .................. ........... ..... ................. ......... ........ ....... ......... x ......... a ......... x ... .............. Barn' No. 2.. $ .............. .................. .................. .................. .................. ....................... X­­ BarnNo. 3.. $ ................................................... .................. .................. ..................... ......... x a X 114 .................$ ................. .............. ................. ......... ........ .................. ........... ......... ......... x ........ a ..... ..x ..... .............. Loss, if any on buildings, payable to............ ..................... .... ........................................................................................... ................................. Mortgagee...... , as................ Interest...... may appear. Wliat buildings, if any, are equipped with lightning rods?................................................................ Name of manufacturer? .............................................................. Date installed ? .......................... Are all ground connections satisfactory ? ............ "Total insurance on rodded buildings $ ............... ; 25 percent discount for rodded buildings $.............. Has the Applicant ever had a fire? ............... If so, give origin and explanation.................... ......................... fiaz the Applicant any special reason to fear fire from incendiarism? ............... Is there any other Insurance on this erverty, or any other exposed with it, in this Company?............ If so, state amount $.............. Name of Insured............ .................. No. of Poliev ................. Is there any other Insurance in any other Company? ......... If so, state amount Ind what it covers, on back. What is your title or interest in the property ? .................................... ..... How inucti 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 inspect the risk inside and outside? ........... ............... Did you then inspect the chinineys and pipes where they pass through partitions and floors and enter chimneys? .................. THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Cayuga County, N. V. for the term of �........vears from the.. day of. t 'I` �•::- ......192/. at noon, tote., ... gday of;.... 192` at on, i property located on th ...... ,.side of..,/ ............ road, .... ...miles from ...... ... ..:....64n....in the town of K................ County of..................................and State of New York, as follows .— Amount Insured $./..Q.,1. � .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 Barn No.. i....�...............................�6s �� $....��...On Barn No. 2 $ ..................On Barn No. 3 $..............,,0On Barn No. 4 $....1..,.8n 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......................................................... $............. A,. ... 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 whorA occupied ? ` Is it painted outside?fre -! .::"Inside ? . ...... In what repair? �' `........ �... Is the fir,,t s ory plastered .:........:.... Second story ?..,ram ........... the chhnnevs :.. air of brick ?.'.:.... Are they in good condition ?. .::,; How hig above the roof is the lowest,? ...........feet. The pipes are in good condit'oni safely secured and enter the chi►niby 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 Yosts House......... $.......................................... ................... [� .si a ....... x.;....... ............ Barn No. L. $..�. .... .............. �.,, ..... r............. .?x. ........ x........ .. .. BarnNo. 2..$................................ ........................................................................ ......... x......... a......... x........ .1... ... BarnNo. K $ ................................................................ x......... a ......... x........ ............ ..................$........... ..... ............... ................. ..................................................... ....... x......... a ......... x........ ............ Loss, if any on buildings, payable to---a_-2 -- __------------------------------------------------- --------------------Mortgagee----, as -------------- Interest-__- may appear. What buildings, if any, are equipped with lightning rods?.....y..7..:::'..................................... 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 ?.., .1b. �..'..... If so, state amount $................11 Name of Insured......s................................ No. of Policv ..... ........... Is there any Insurance in any other Corn . ..pany ?`..f. 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, duriug my membership. Given in pursuance of §Section 7 of the, Act under wJiieb 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 ? �c�'� y p e and outside .............�......... Did you then inspect the chimneys and pipe here they pass through partitions and floors and enter chimneys?...... Are they apparently safe ?..... ,y..; .. Do you know of any acts creating moral hazard?!,�,�?........ •y�' •,_Solicitor. iRMERS' MUTUAL0 d 11TY ASSOCIATION 0 0 Cayuga County 00 0 --------------------- 0 ,I • 10 F' �.... 0 ..........ZZ. D.....4 .......... - 0 0 .. ...... ....... 0 z....................... 0 .... ....t...!•.....��?.f. `�.. ... ..... .... SOLICITOR. 0 �.. _ 0 'olicy ltie:��.„E'/�-: ....0 N ��� d�9.1�d �1•d 4 • Material of house No. 2 Age............years. Iwhat repair?........ .......... � 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. 5 G EAST 0 t>, � L Q ..fir U O] bD o f............ _. _ _ ....,� . G G G p O O r✓ �� 0 l �Nj p L7� F r- o A L° a • � Cu0 c -: NEST �+ cam► � � m THE FARMERS' MUTUAL p INDEMNITY ASSOCIATION of Cayuga County00 J 0 0 jjA TI N OF .....` : �,:... R. D. . County of. , .. ............ State of..... .. .. ................ Townof....:.... :................. ............ • 0 + Premium ..'%/ .... ................ $..... ...... ;...., 0 0 Discount for approved 0 0 Lightning Rods .................... $.................. 0 0 Total ................................... .................. 0 0 0 0 Date of Risk......P`i� Time......... .........years. 0 SOLICITOR. 0 0 Renewal of Policy No..�.f.J�t4,�.:!C}..:,..... Reinsured No. ....... i�'.,.t�...Cf...t1............. 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 " QA 6%. ....................................................... .................. OLICITOR. EAST E O O y H A WEST ZIPPIication of,�........................ R. F. D., No ............. Postof%ce....... ... XC:___.�.._� County of .......................................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNVY�SSOCIATION, of Cayuga County, Nf,Ya� for the term ?L-- ........years from the .........da ofG .....192,E at noon to thee.... ( y .. ........ . ... ..day of...................19..... at n96 on pr erty located on the'. . ...aide of . ...............road, .. �. � files from. ` .` .. .. L ..in the town of • • (L�: .....County of._ ... .. .............an State of New York, as follows: — Amount Insure $•� ..U...Un 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......................................................... $•� � 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 `j ..On Produce on Premises b?JL4am,�.� 1 $ .................On Farming Utensils, Carriages, SleiAs, Robes, Harness and Automobiles on premises $ ..................On Horses $ ..................On Cattle $ ..................On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On........................................................ $ ....... On ......................................................... . d...Total ............Rate ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $.................. How many stories in dwelling House ?............ By whom occupied?...................................................... Is it painted outside? ............ Inside ? ............... In what repair?.................. Is the first story plastered?............... Second story-?.................. Are the chimneys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ?I Cover Roof Condition I How Finished Painted SIZE OF BUILDINGS Height House.........$............................................... BarnNo. ] .. $................. .......... _ .. ................ BarnNo. 2..$:............................... ................ BarnNo. 3.. $ ............................. ............... ........ .................... ................... .........x ........ a ......... x........ ............'....................................... ....... x........ a........ x........ ................................................. ......... x......... a......... x........ ................................................................ x......... a ......... x........ of Posts ..................$........... ..... .............. .................. I .................. ....................... .................. ........ 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? .............. 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. .....................................................................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 nhin,nPVQ? ®1�^b1► �11� A��1�� �rv�1 •N�1 � THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County� 0 ------------- $ 0 AF � ION OF . %............... .................... ................... R. D..� ............. . County State of..........�� ............ . Townof .................................................. ..... ................ E..J�...�� Premium..... Discount for approved Lightning Rods .................... $...... ............ 1 /. L Total ...............................:...$ ....� 00$ w 0 Date of Risk. ... .......<'"f�..193.:i Time...... ........ ..........years. A P 0 s�................. ............ P SOLICITOR. 0 0 Renewal of Policy No.-.:.��.'`: 0 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?........... N H 0 z ....................................................... .................. OLICITOR. EAST `VEST 0 0 =o a� 3 d CL a� Cd � o b � 0 o 'd Cd E � o 0 /� ZiPplication 0�... '/! ........... R. F. D., No. ffi Postoce.!1, . County of .......................................... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITTY_ S CIATION, of Cayuga County, N. for the term of..... .......years from the.A_41? day of..[ 192. oo h v� ,e ,� t e .�?� day of.���..192.` ......... at noon, on property located on the ........... ' Of..................road, ....�l...miles from........... .... ..:L:.......in the town of r ....................................County 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, $A.7„ Ji0....Oil Produce oil Premises (ft Pictures, Silver and Plate, Provisions $...... ........... On Farming Utensils, Carriages, Sleighs, and Wearing Apparel on premises. Robes, Harness and Automobiles on $ ..................On Piano ; $............... Organ ; $......... � &Ic,lo • • • •• premises - Melodeon. ... �.................. $.................. On Horses $ ..................On Cattle ...On Barn 1\ -0. 1 /f, �,, .................. On Registered Cattle ... .. .....�.._--'��'��C�t/J $ ..................On Barn No. 2 $.................. On Sheep ....On Barn No. 3 $ ..................On Fowls $ ..................On Barn No. 4$.................. On ............... ........................ ................. $ ..................On Hog House $.................. On......................................................... $ ..................On Hen House $�P.:J..�.Total ........... a .R to ................Premium How many acres of land in this place ?............ What is the value of the land and buildings? $.................. How many stories in dwelling house ?............ By whom occupied?...................................................... Is it painted outside? ............ Inside ............... In what repair? .................. Is the first story plastered? ............... Second story? .................. Are the chimneys all of brick ?......... Are they in good condition ?......... How high above the roof is the lowest ? ...........feet. The pipes are in good condition, safely secured and enter the chimney horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ?I, Corer Roof Condition How Finished Painted SIZE OF BUILDINGS Height House.........$............................................... ...... x ........ Y. a x o oats G l ............ BarnNo. 1.$ ............................... ................ j 0 ..................................................... ��.p�,�........ x........ ..�c�.... ,(�.� x BarnNo. 2..$................................ ................�'.................... ........ xa. x ........... 5 . Barn No. 3.. $ ............................. l Q� . . ........................x......... a ......... x........ ............ ..................$ ........... ..... ............... ................. .... ..... .. Loss, if any on buildings, payable to --------------------- as -------------- Interest ---- may appear. . What buildings, if any, are equipped with lightning rods?..�.. .......................4 ............. 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 ever had a fire? If so, give origin and explanation .............. Has the Applicant any spacial 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 ?.........._— _ 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, 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 following Questions :— Have you carefully examined the above risk?............ When did you inspect the risk inside and outside?.���.�..... o Did yu then inspect the chimneys and pipes where they pass through partitions and floors and Pnter nhirnnAUQ ? THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County 0 0 ' o'_ �A �--=� -----/-------- $ 0 0 �'�ON OF ............................... . ... ............... Z.:,..R. D.,�............... County ot. ...�'�J....... State of........ .. ...................... Townof ...... ....................................... -6�-------- 00 / d tr7 Pl'ellllum..... ..................... $ f• Discount for approved 0 o Lightning Rods ................... 4................ � 0 /Q J� 0 0 Total..........................................R........ Tate of Risk ... ........ 19•L.,l Time ...... .................. years. SOLICITOR. - 0 Renewal of Policy No..-.--?...• ............... 0 Reinsured No.,-.......:'i� .. ... �....... .......... Material of house No. ............................... Age ............ years. In what repair?............................... Is it necessary and 0 Is it painted ?..... Is it plastered Are the stoves remunerative in its present condition? .................. P P ••• pipes and chimneys in good condition and apparently safe? ....................... Where and how are ashes kept ? ....................................................... .................SOLICITOR. s EAST 0 U m 0 00 � U '•d c , Z y p" Cl) o r -+ vl o H o a �• 3 0 b \ �CS b du 0 0 0 WEST �' 1 zl pal I1CatIO1t Of ... ...... ..... .. ... ...... R. F. D No.. Postoffi ce. ... . ... ., ..... Countv of..... , ..........\......... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAk !NDEMNI Y S CIATI©N, of Cayuga County, N�J�V. for the term 0.1— ........ •ears from the.. ....day of....... . .... ..192./ at noon to th�...day ofC?.` Y ......192. at no n, on perry located on tl ... ids o�/................road, ..1....miles fmnr....'�Z�...-t.�,�.in the town of ••• .................County of.. .... ..._. LY.t:nd State of New York, as follows: — Amount Amount Insured Insured 4.. r2.2.O.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 Wearing Apparel on premises. Robes, Harness and Automobiles on $.... ........On Piauo ; $............... Organ ; $..... f...... premises M deo $ ... ..On ....... .. $ ..................On Horses $ ..................On... $.................. On Cattle $• .................On Barn No. 1 �• . $ ..................On Registered Cattle a $.�.....�f...On B $ ..................On Sheep rn No. 2 $ ..................On Barn No. 3 $ ................On Fowls $ ..................On Barn No. 4$.................. On ............... ........................ ................. $ ..................On Hog House $.......... On ......................................................... ................................... .................. On Hen House $.�P .... ? .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 ? ......W who occupied ?.......-— :::.................... Is it painted outside?., c Inside In what repair?. .... Is the first story plastered??ove .. Second story ?.'.. ........ Are h /Y��� e the chimneys all of brick ?..W.. Are they in good condition ?s�• How high a the roof is the lowes't_�.......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 ? Coveploof Condition How Finished Painted SIZE OF BUILDINGS Height House......... $....~:............... �;....................... . iX-i•...... ........ ....... ....... ....... of Yost x a. x. BarnNo. I. $...... ..... ........ ................ ..aa. ................. ...... xa. x ... ....... Barn No. 2.. $.... ...... .... .............. ................ ..v.��......... "_"1 .� x. a........x....... ...�..'`J.... BarnNo. 3.. $ ............................. ................ ................. ..................$ ........... ..... ............... ................. .......................................................... ........ x......... a ......... x........ ............ Loss, if any on buildings, payable to ---------------------------------------------------------------- --------------------rlortgagee____, as -------------- Interest=,.._ may appear. / What buildings, if any, are equipped with lightning rods? .. .... ...... ��-:G............... 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?..J--�.-Q.. If so, give origin and explanation................ ............................. Has the Applicant any special reason to fear fire from incendiarism 1_2,2,V.... 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 Policv ..... ........... 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 ?................... ....... L5..��..... ............... 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?.1�. Did you then inspect the chimneys and pip where the through art' Y pass g partitions and floors and enter chimnevq?__ __ i k FARMERS' MUTUAL INDEMNITY ASSOCIATION0 0 d of Cayuga County, APPLIC'.ATION OF County of.....C.l .. ��z ;+F �!-�, ..... /j.� Stateof.......... ......./. �L........ ...... � Town of...... ...... 4!.............. d� L/ 0 Premium................................ZoZ.��.�. d 1. Survey Fee ......................... $ .1�:`� ...4:: 0 v. Total ..... ..................... ........ ..� Risk... AP-1^.....3.........lf)1' Date of Time ..........6 ......... years. 0 H SOLICITOR. Renewal of Policy No ... ......... $ Reinsured Nc�............................�'�.,�..... ..... 0 t� l� Material of house No. 2................................ Age ............... years. In what repair ? ...... ................... Is it necessary and a remunerative in its present condition ?.................... Is it painted? ....................... Is it plastered? Are the stoves, pipes o and chimneys in good condition and apparently safe ................ Where and how are ashes kept ?.................................. East jga'4, 9 ............... SOLICITOR. a 0 b 0 o � 0 C U a y ? C a� a� p :t ... o � m o C C d 0 v L a� 0 :3 v� U e a � b m b � m m t zipplicattoll It. F. D. No..6_. Postutfice ..... ....... County of ...........and State of New York, for insurance against loss or damage by fire or lightning in the FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N. V. for the term of ...... 6 . . ...... vears from the..........day of e'76-. ....... lm.fat noon, to the .... :K ...... day of..-A,,C7� ..... 1 at noon, on property located in the town of. .. .......... it., :49ty of Cayuga and State of New York, as follows: Ainotint Value of Height Insured Buildings, of Posts SIZE OF BUILDINGS On D%%elling House and Attachments ................................ $ ............. .............. ............... ..... .... 1. x ...........a ...........x ............ On Household Furniture, Provisions and Wearing Apparel therein and on premises ..................... ............. $0A Oil Piano, $ ......... Organ, Melodeon, $ ......... therein ..... On Printed Books, Pictures, Silver andPlate therein......... ........... J* F On.............................................. ................... ............... ...... OnBarn No. I ......................................... ....................... .............. On Barn No. 2 ........... x ............ a ............ x............ On Barn No. 3 x............ a ............ x .......... OilBarn No. 4 ............ ................ .... ............................. .................... On Corn Barn or Granary ......................................... ...... .......... x............ a ............ x ............ On Produce in said Barns and on Premises ................... ...... ... PRESENT NO. OF ANIMALS On ........... 9.U4i ................ ....... I ....... ... ........... ............ Horses............... Cattle ............... On Farm Utensils, Carriages, Sleighs, Robes and Harnesses Sheep ................. Fowls............... in said buildings and * Premises......... .... .. INDIVIDUAL LIMIT ON On Live Stock, On Horses, $3AP011 Cattle, $4- Horses $ ............... Cattle $ ............. to -wit �OnSheep, $ ........ On Fowls, Sheep',',� .................. Fowls $.............. ............... ................. Total. <.F ".9 C/ Pretnium ..... ................ ...... 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. How many stories ? ............ For what is it occupied 9 ................. By whom ? ........................... . Is it painted outside ? ........... Inside 9 ............... 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 buildino, or in ................................................. Barns —Material. How Old? Cover of Roof. Condition. How Finished ? Painted. No. I ................... .......................... ................ ......... ........................ . ...... ......... ....................... ........ .................... No. 2 ............................................. ....................... ...... ................. .......................... ....................... No. 3 .................. ........................... .................. ........ .............. ........... ............................................ ..... ........................... .. ............. ....... ....... ................. .......................... ................................. .............. ....... ........ ......... 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 from incendiarism ? ............ Is there any other Insurance on this property, or any other exposed with it, ill this Company ? ............ If so, state amount $............ Name of In-,ured .......................................... No. of Policy.................. Is there any Insurance in any other Company ? ............ If so, state amount and what it covers, )I'pl 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 wliieli the Association is Organ - zed and in conformity with the By -Laws of the Association. In ............................... ** ... **­­­**********­ ............. ... 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 � �'i'��►ail.�:►'�1►'ll►�+►��1�♦1.�"�'�'�• THE FARMERS' MUTUAL INDEMNITY ASSOCIATION of Cayuga County ---------------- CATION OF � ca ... .......R. D,.................. County of. .. .... ....... Stateof ........ ......................................... . Townof . ...... ...... ............................. / I Premium.......... ................ $..... ............ Discount for approved i Lightning Rode .................... $......... ......... Total .................................... $.G 476. .. -- — Date of Rie .....�. ...........19Z' Time ...........v..........years. P i SOLICITOR. i Renewal of Policy No ..... .. .........�:....... Reinsured No.....� ......:'. ... ..... .Material of house No. _ ................................. Age ............ yeare. In what repair? ........ ............. I......... to it necessary and 0 remunerative in its present .................. conditions 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 s EAST � � o � o i • a� � 3 . b al { W 0 z NEST m 0 y x I -Al ZIPPlICation of... R. F. D. No ............. Postoffice. i County of.....................L ................. and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITV ASSOCIATION, of Cayuga County, N, �Z..day�,f ...6...........19?.�at noon �,o t�e .� day of...... ...192 for the term o ... years from the .... *Ionyrvperty located on the... � .side of,-? ........ ad, &.mi el s from...............`Q� � :`.�-�...in the town of ..i: it '5J......County of.....' ... Y1 ! ' and State of New .York., as follows:— Amount Insured $! .I/.&.On Dwelling House and Attachments $... 3S_'rP..On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions ` and Wearing Apparel on premises. $...... v......On Piano ; •Ip............... `)PgtrrT ........ Melodeon $.......�On .. ...................................... $.....%.. P..0 ...... .. ................ .,.............. .•,•,. $.. $..A :....On Barn No. 2 On Y%� $........ ... On 11, J._', • L• $....... .P..On Hog House $......... 0?,�..On Hen House Amount Insured $ ..................On Corn Barn or Granary $1Q.0Q.... On Produce on Premises $.... A0.0-On Farming Utensils, Carriages, Sleighs, Robes, Harness and Automobiles on premises $....... . ..On Horses $...3•.6k ..On Cattle 9t- $ ..................On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On........................................................ $......../.......... On ......................................................... $�l 4,j Total ............Rate ................Premium How many acres of land in this place ?.l What is the value of the land and buildings? $................. How many stories in dwellinghouse • � ? �...: By whom occupied ?........ ................... Is it painted outside? Inside ? .. . ..... In what repair?.. ....... ... Is the first tory plastered? Second Second story�..,r%sl.......... re the chimneys fall of brick ?.. Are th in o d condition ?. How high a ve the roof is the low set ? •....••..•feet. The pipes are in g PP good Condit' n, safely secured and enter the chiin ey horizontally by a thimble or are firmly cemented therein. All wood ashes are kept at least thirty feet from any insured building or in.............................................................. Material Value How Old ? Cover Roof Condition How Finished Painted SIZE OF BUILDINGS Height House.........$............................................... ................. ................... ................... 1 ....x ..../ �U o osts fY a ............ BarnNo. L. $................. ............. ................ � ...................................................... �..�: x �. � a / (. x. 6 5 BarnNo. 2.. ................. .............. ................ ....................................................... xa........x........ BarnNo. K $ .... .. ... .. ........... ... • ...-........ ..• . .........x....... $........... ............................!Q.. x�3.1:�. a ......... x........ Loss, if any on b 'I ' gs, Pay--------------- --v - - ---- - =------------ ---------------___--------- ________ _______11ortgagee___as nterest___- maappear. What buildings, if any, are equipped with lightning rods? ................ ...................... I........................ Name of manufacturer? ••••••••••••••••••.••••••••...................................... Date installed?........................ Are all ground connections satisfactory?............ Total insurance on rodded buildings $............... : 25 per cent discouq,t-ft5f rodded buildings $........ ..... Has the Applicant ever O had a fire?.'+,./...•... If so, give origin and explanation ............................................. Has the Applicant any special reason to fear fire from in�diarism? ...Y..L°... Is there any other Insurance on this property, or any other exposed with it, in this Company ?............... If so, state amount $............s!Name of Insured........... ....................... No. of Policy............ Is there any Insurance in any other Company ?.�. : `� 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 herebv 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. A,, .......t ...,...... A-4... .... z .-'.t.rlpplieant. The Solicitor will please answer the following Questions Have you carefullyexamined the above risk?.. v ,.`When did you inspect the risk inside and out,.ide 7 Did Vnn t.hp..n incnnrt. t.hP r•hi,nnPva anr3 Winne }.­ 41,o., --a 13 _ _ 1 1 . - MA MIAIM51 THE FARMERS' MUTUAL :0 INDEMNITY ASSOCIATION $ d b of Cayuga County 0 oVo.------------------ -------- 0 0 0 A P,LIOATION QF d ...........R. D. .......... Countyof .............................................. PState of .................................................. Townof ......................... ...................... 0 Premium ........................... $.... i.d...... / m0� Survey Fee ...........................$.................. Total.................................$..d ..,..?... Date of Risk. Time ..... ............. years. �.... a91TOR. .............. S 0 Renewal of Policv No..�j .. ....y................ Reinsured No..........,..S.,. .......... Material of house No. ............................... Age ............ years. In what repair? ..... Is it necessary and ............................ remunerative in its present condition? ............ r..... Is it painted? ................. Is it plastered? Are the stoves, pipes and chimneys in good condition and apparently safe ?....................... `'Where and how are ashes kept ?......... .............. t Cd o� 0 0 0 f �! �i H A .......................................................................... SOLICITOR. EAST H o Z Isam �a 0 a 3 c CS 0 � o y cc v m a� n-2 b0 o o •o 0 ad tw ce C3 L b es 0 Eppitcatton of.,,0.... ........... , R. F. D. No ............. PostoHice.....:..40 ,, ........ . Countv of...,l wa.......... and State of New York, for insurance against loss or damage by fire or lightning in THE FARMERS' MUTUAL INDEMNITY ASSOCIATION, of Caji County, N. for the term of............vears from the.l.L�...day of.. ,� L9`?� at noon, t......day of ��........19?. / fat noon, on property located on the/WAij�side of�. � oad, ....I....miles from..�.. ...in the town of ?:.�.tCounty of..a•• .........an State of New York, as follows :— Amount Insured $j.ZA. On Dwelling House and Attachments $.... JI.G�.l..On Household Furniture, Printed Books, Pictures, Silver and Plate, Provisions and Wearing Apparel on premises. 43 $ ..................On Piano ; $...............Organ ; $.............. Melodeon. $..................On.......................................................... $............... On ......................................................... $..j!1% .....`....On Barn No. I $ ..................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 $.... SA!. .On Produce on Premises $.... d..pp�Y...q...on Farming Utensils, Carriages, Sleighs, Robes, Harness and ito no iles on premises O/n $ ..................On Horses $ ..................On Cattle $ ..................On Registered Cattle $ ..................On Sheep $ ..................On Fowls $..................On........................................................ $.316'.°. Total ............ Rate.71...v� ...Premium t How many acres of land in this place ?...... What is the value of the land and buildings? $...�'y...t. d How many stories � f• in dwelling house ?../.k... B whom occupied ?,ltl+.. P.'?!1� •......... Is it painted outside? ... Inside ? !!. ..... In what repair ?..,l..O J7 01. Is the first story plastered. `?..ld ... Second story ?..d ...... Are the chimneys all of brick Are they in good condition ? (1, How high above the roof is the lowest ? ...'......feet. The pipes are in good condition, safely secured and enter the chimneUUy lh�orizontallyy�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'? CoovprrRoof Condition How Finished Painted SIZE OFBUILDINGSHeight 1 �© �� !' ".' �.! �...................... .... �//_p�S_...... � __ to l a ------ x ----- of Posts House......... $..'"". x Barn No. L. $...` �� .............. .............. U!��!. ... ....� �.... � -� x6-�'�a-----x------------- BarnNo. 2..$................................ ..........................................................................------ x----- -a ------ x ----- BarnNo. 3.. $ ............................. ................ .......................................................------ x------ a ------ x ----- ..................$ ........... ..... ............... ................. ..........................................................------ x------ a ------ x----- -------- Loss, if any on buildings, payable to _ _ "'"'L►,r,,, ---- ------------------ ------------------------------ --------------------rlortgagee_---, 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 ? .(-t i. 4? .. Is there any other Insurance on this property, or any other exposed with it, in this Company ?...1k0... If so, state amount $............... Name of Insured ....................................... No. of Policy................ Is there any Insurance in any other Corn any ?............ If so, state amount and what it covers, on back. `i'hat is your title or interest in the property ? ........�i ............................ 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, sristained 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?..d When did you inspect the risk inside and outside?.� 7' ......... Did you then inspect the chimneys and pipes where they pass throughpartitions and floors and enter chrmnevs ? ... Ara thaw nnnarantly cafaT Drnl JM�....... C1'6 THE FARMERS' [11.1UTUAL 0 0 0 0 '0 INDEMN, IT ASSOCIATION '0 0 0 of Cayuga County 0 Io__v___' _ $ 0 �PP IC ' N U ........................................:::.... . R. I) .............. County of.... .0 0 State of........ .. .. ............ 0 town of .......... .... —---- 0 0 8'. &---c 0 Premium ........................... Survey Fee ........................... ................. 0 Total....................................aF..P`'. Date of Riek......... , . . .....19.2r. Time. .J. ... ... ears. — --01 ...................................... SOLICITOR. 0 i Renewal of Poliev No........ .......... 0 Reinsured No..'�:. ... '?.. ..��................ 0 • ...... ............ Age ears. -Material of house No. 2............ ... g •3' In what repair?............................... Is it ne:essar and Y a • ................... remunerative in its present condition? .................. Is it painted? Is it plastered? .................. Are the stoveF, 0 � pipes and chimneys in good condition and apparently safe? ....................... Where and how are ashes kept? ........................ U .........................................................................SOLICITOR. a EAST a 0 E 0 � o a � 1 4 I•} ; w � ;.d p O en a Z x o P0 a: 5 • i 3 p M 0 0 1 0 0 WEST � i zippIICattori ....... ........... ....................... R. F. D., No............. Postoflice....................... Countv of.... ....... .4-L_........... and State of New York, for insurance against loss or damage by fire or lightning in _ FA MEIZS' MUTUAL. IN®EMNIT ASSOC ATION, of Cayuga County, N. for the term crf�` ......years from the../.......day c,f...... ..............I9?�. at noon, to the . day of.... 19 - t oo , on property lo:gted on tl _.......side ..................road, .........miles from .................................... in the town of ...County of. 1... d State of New York, as follows :— Amount Insured -•+Q. ...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......................................................... a*..0...... On Barn No. 1 $ ..................On Barn No. 2 $ ..................On Barn No. 3 $ ..................On Barn No. 4 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 Hog House $ .................. On ...................................... ................... $ ..................On Hen House $... 5?.. —0—Total ............Rate ................Premium How many acres of land in this place ?............ Wbat is the value of the land and buildings? $................. How many stories in dwelling house ..... By whom occupied ?................................................... Is it painted outside ?.... r:. Inside? ZI �In what repair?�%'� :!<.' T Is the first story plastered?.. Second story ?...j,tt_�..... Xre the chimneys of brick ?.. Are they in good condition ?.....:d How high ab vb e the roof is the lowest ?Q...t�.....feet. The pipes are in Y g `� f P P 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. $............................. ................ .................. ....... x........ a........ x........ ............ BarnNo. 2..$................................ ....................... x......... a ......... x........ ........... . ................................................................x.........a.........x........ ........... Barn No. 3.. $ ............................ .................. $........... ..... .............. . ....................................................... I................. ........ 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?)....tl........ 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 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 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?