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# of families		Owner occupied	Yes No
Age of dwelling or yr built		Style of house
# of stories		1st floor Sq ft
Kitchen	(list #)	Living room
Bedrooms		Dining room
Full bath		Half bath
Family room		Laundy room	Yes No
Basement	Yes No	Porch	Yes No
Deck	Yes No	Garage	Yes No
Central heat	Yes No	Central Air	Yes No
Fire place	Yes No	Woodstove	Yes No
Smokers	Yes No	Smoke detector	Yes No
Burglar alarm	Yes No	Own a computer	Yes No
Any business conducted on premises	Yes No	Any claims in 3yrs	Yes No
Claim description (if any)		Any recreational vehicles	Yes No