De Smet Agency
Serving the Superior Area since 1963
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Year Home was Built
*
Home Address
Roof (Year Updated)
Furnace (Year Updated)
Plumbing (Year Updated)
Electrical (Year Updated)
Size of Home (Square Feet)
Type of Roof
Wood Shake
Asphalt Shingles
Flat
Cement
Tile
Metal
Other
Hazards
Swimming Pool
Trampoline
Dog
Other
Construction
*
Wood Frame
Brick
Other
Safety Devices
Smoke Alarm
Dead Bolts
Fire Extinguisher
Local Alarm
Monitored Alarm
Date Purchased
*
Owner's Name
*
Owner's Date of Birth
*
Contact Phone Number
Contact Email
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