


| System or Component |
Current Depreciation Value |
| Roof Coverings | $ __________ |
| Roof Drainage System | $ __________ |
| Chimney (s) | $__________ |
| Principal Windows | $__________ |
| Detached Garage | $__________ |
| Driveway/Walkways | $__________ |
| Porches/Decks | $__________ |
| Furnace/Boiler | $__________ |
| Electric Air Cleaner/Humidifier | $__________ |
| Central Air Conditioning Unit | $__________ |
| Electrical Branch Wiring/Panel | $__________ |
| Shower/Tub Enclosure (s) | $__________ |
| Finished Floor Coverings | $__________ |
| Kitchen (s) | $__________ |
| Bathroom (s) | $__________ |
| $__________ | |
| $__________ | |
| Appliances (if applicable) | |
| Clothes Dryer | $__________ |
| Washing Machine | $__________ |
| Refrigeration | $__________ |
| Oven/Cooktop | $__________ |
| Dishwasher | $__________ |
| Central Vacuum | $__________ |
| $__________ | |
| $__________ |