FARM PERSONAL PROPERTY INVENTORY_______________________________________________and

__________________ MUTUAL INSURANCE COMPANY(To Be Used With Renewal Application)

APPLICANT/INSURED _____________________________________________ POLICY NO. _____________________

SCHEDULED FARM PERSONAL PROPERTY UNSCHEDULED FARM PERSONAL PROPERTYLIVESTOCK

CATTLE # Value Total101 Dairy Cows _____@______$ ___________102 Heifers _____@______$ ___________103 Dairy Calve _____@______$ ___________104 Feeder Cattle _____@______$ ___________105 Stock Cattle _____@______$ ___________106 Bull _____@______$ ___________107 Registered Cattl _____@______$ ___________

SHEEP111 Ewes _____@______$ ___________112 Rams _____@______$ ___________113 Lamb _____@______$ ___________

HOGS121 Sows _____@______$ __________122 Boars _____@______$ ___________123 Feeder Pig _____@______$ ___________

131 HORSES _____@______$ ___________

1 TOTAL LIVESTOCK ...................... $

POULTRY201 Hen _____@______$ __________202 Fryer _____@______$ ___________

2 TOTAL POULTRY .......................... $

HAY, STRAW AND FODDER301 Hay _____@______$ ___________302 Straw _____@______$ ___________303 Fodder/Silage _____@______$ ___________

3 TOTAL HAY, STRAW & FODDER $

GRAIN, FEED AND SUPPLIES401 Corn _____@______$ ___________402 Soybeans _____@______$ ___________403 Wheat _____@______$ ___________404 Oats _____@______$ ___________405 Sunflower _____@______$ ___________406 Farm Chemicals _____@______$ ___________411 Veterinary Supplies _____@______$ ___________420 Fuel, Oil & Greas _____@______$ ___________ ______@______$ ___________________________ _____@______$ __________

430 Commercial Fee _____@______$ __________431 Ground Feed _____@______$ ___________

4 TOTAL GRAIN, FEED & SUP. ...... $

FARM MACHINERY AND EQUIPMENT501 Tractors ValueNo. 1 ____________ __ $ ___________No. 2 _______________ $ ___________No. 3 _______________ $ ___________No. 4 _______________ $ __________502 Garden Tractor____ $ ___________503 Skid Loader ______ $ ______________________________ $ ___________

510 Combine No. 1 _____$ ___________Combine No. 2 _______ $ ___________Combine Heads ______ $ ___________513 Swather________ $ ___________514 Picker/Sheller___ $ ___________515 Other Self Propelled:___________________ $ ___________

520 Port. Elevator_____ $ ___________521 Port. Auger No. 1__ $ ___________Port. Auger No. 2 _____ $ ______________________________ $ ___________

530 Bale Racks & Trailers $ ___________Beet Defoliators ______ $ ___________Beet Lifters __________ $ ___________Beet Planters ________ $ ___________Beet Thinners ________ $ ___________535 Chisel Plow_______ $ ___________536 Corn Planter______ $ ___________537 Crop Sprayer ______$ ___________538 Drill Seeder _______$ ___________539 Disc _____________$ ____________540 Drag ____________$ ____________541 Fert. Spreader _____$____________542 Field Cultivator ____$ ___________543 Grain Wagons _____$ ___________544 Grinder/Mixer/Mill __$ ___________545 Hay Baler _______ $ __________546 Hay/Crimper/Bine _ $ ___________547 Hay Stacker Loader $ ___________548 Hay Stack Mover__ $ ___________549 Livestock Trailer (Unlicensed)$_____550 Mach. Trailer (Unlicensed) $_______551 Manure Spreader _ _$__________

552 Mower ___________ $ _______553 Plows ______________ $ _______Potato Digger ________ $ ________555 Rakes _____________ $ ______556 Rotary Tiller/Hoe ______ $ ________557 Row Cultivator ________ $ _________558 Silage Wagon ________ $ _______559 Silage Cutter/Blower ___ $ _________560 Stalk Cutter __________ $ _________561 Snow Blower _________ $ _________562 Spraying Tank ________ $ _________563 Tractor Loader _______ $ _________564 Vaculator ____________ $ _________

TOOLS AND MISC. EQUIPMENT:601 Electric Motors ______ $ _________602 Fuel Tanks _________ $ _________603 Port. Generator _____ $ ________604 Spare Parts ________ $ _________605 Power Tools ________ $ _________606 Hand Tools _________ $ _________607 Welder ____________ $ ________608 Compressor ________ $ ________609 Bldg/Fencing Material $ _________610 Misc. Tools & Equip ___ $ __________________________ $ _____________________________ $ _____________________________ $ ___________

5 TOTAL FARMMACHINERYANDEQUIPMENT ............. $

INSTALLED EQUIPMENT(Must be Scheduled if not included

in building value)Bulk Tank/Cooler ____ $ ___________Milk House Equip. ____ $ ___________Milking Mach. Equip. __ $ ___________Hog House Equip. ____ $ ___________Poultry Equipment ____ $ ___________Silo Unloader ________ $ ___________

__________________ $ _____________________________ $ ___________

6 TOTAL INSTALLEDEQUIPMENT ............. $

7 TOTAL SCHEDULED VALUE 8 TOTAL UNSCHEDULED VALUE(Add 1 through 6) $_______________ (Add 1 through 5) $______________

Comments:

CF-1008 (Ed. 6-09) - OVER -

Policy provisions require individualscheduling of above items when notbeing used in Unscheduled Farm Per-sonal Property. Following items maybe optionally scheduled.

UNDERWRITING GUIDEComplete this underwriting guide or the underwriting guide provided by your Township Mutual. Attach to renewal application.

DWELLING:1. Occupancy: Owner Tenant Vacant Seasonal Under Construction2. Any additions/improvements? Yes No If yes, please explain:

_____________________________________________________________________________________________3. Any wood heating? Yes No If yes, please explain: ___________________________________________

_____________________________________________________________________________________________OUTBUILDINGS:1. Occupancy: Owner Tenant Vacant2. Any change in use of buildings? Yes No If yes, please explain: ________________________________

_____________________________________________________________________________________________3. Any additions/improvements? Yes No If yes, please explain: ________________________________

_____________________________________________________________________________________________4. Any heating systems? (including wood heat) Yes No If yes, please explain: _______________________

_____________________________________________________________________________________________GENERAL:1. Any restrictions in coverage? Yes No If yes, please explain: _______________________________

_____________________________________________________________________________________________2. Any existing damage to property? Yes No If yes, please explain: _______________________________

_____________________________________________________________________________________________3. Any other insurance applying to property insured? Yes No If yes, please explain: ___________________

_____________________________________________________________________________________________OTHER:1. _____________________________________________________________________________________________

2. _____________________________________________________________________________________________

3. _____________________________________________________________________________________________

MAFMIC FORMS AVAILABLEYes/No

x

Yes/No

TP1 General Policy Provisions Q Added Perils for Refrigerated Food Products7S Amended Theft (Expanded Coverage)

AM Amended Failure to Match(Included A1 & A5 - Not Available A2 & A3)

7U Backup of Sewers, Drains or Sump Systems(Coverage A - Coverage C)

6K Blizzard Death Coverage - Livestock P Collapse - Due to Weight of Ice, Snow or Sleet7W Collision and/or Overturn (Coverage E, Coverage F)7Y Collision and/or Overturn (Coverage E, Coverage F) Z Coverage Adjustment Endorsement6S Debris Removal7X Expanded Vehicle Damage T Farm Extra Expense R Glass Coverage (All Mobile Farm Equipment)

Optional Deductible $_________________6P Livestock Confinement Coverage6J Modified Replacement Cost Coverage for Dwellings

(Agreed Percentage)7B Non-Depreciation of Repairs (Coverage E or F) S Peak Season Inventory Farm Personal Property U Recreational Equipment J Replacement Cost Coverage (Buildings) K Replacement Cost Endorsement (Coverage C)6R Scheduled Cab Glass (Coverage E or F)

Optional Deductible $_________________

7C Amended Vandalism and Malicious Mischief and Theft7D Amended Vandalism and Malicious Mischief7A Collapse - Weight of Ice, Snow or Sleet - (Coverage E or F)6U Collapse - Weight of Ice, Snow or Sleet - (Coverage E or F)7Q Collapse - Weight of Ice, Snow or Sleet - (Coverage G)6W Deferred Loss Payment6X Deferred Loss Payment

W Deferred Loss Payment X Deferred Loss Payment7H Earthquake7P Leased, Rented or Borrowed Farm Machinery, Vehicles and

Equipment of Others (Coverage E)7N Loss of Income (Coverage G)7R Loss of Use or Income (Coverage G)6T Loss of Income or Rent V Restriction of Individual Policies7J Theft Coverage Extension

(Construction Material & Supplies - Coverage A or G)