We have carefully and thoroughly examined the article(s) listed below belonging to:

Name ______________________________________________________________

Address ____________________________________________________________

This estimation is based on the current retail value and is not intended to include any applicable state or federal tax. In the event of any damage to the item(s) described below, the Appraiser is not responsible for the cost of the replacement of said item(s).

Item	Description	Appraised Value

The Appraiser assumes no liability for any action taken based on this appraisal.

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Appraiser Signature                                                                               Date