v2413-1143

Continental Insurance Company, etc

DEFENDANT'S EXHIBIT AA.J

337

Claim Ntfv^ 7 fo , Z Co.

S-

Agent s*^-

Policy No., J7PT j^ay -j

Expires ^; / y^

Total Amt. $ f^ gTgr ^ ,

Amt. of Loss J

^^.

Form a/./^ /t^ . Proof Instructions

Assured

iCl

Res. Address

Bus. Address

Occupation

Dale Lost

Item No.

Location

Appraised By.

Val. Est.

./

Purchased F

Reported-

Remarks

Reporting Instructions:

PAUL, P. QBRIrTM.

f.i.W

/y

j

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