Facsimile of application made by General Robert E. Lee, in 1859, for insurance in the Hartford Fire Insurance Company to cover his dwelling known as the “Mansion House,” situate at Arlington, Virginia.
Hartford Fire Insurance Company, of Hartford, Conn.
The estimated value of Personal Property, and of each Building to be insured, and the sum to be insured on each, must be stated separately. When Personal Property is situated in two or more Buildings, the value and amount to be insured in each must be stated separately. When insurance is wanted on Personal Property, the same description should be given of the Building containing the property, as if Insurance is wanted on the Building.
Application of R. E. Lee, U.S.A., for Insurance against loss or damage by fire by the HARTFORD FIRE INSURANCE COMPANY, in the sum of Five Thousand, Eight Hundred Dollars on the property specified: the value of the property being estimated by the Applicant.
SUM TO BE INSURED VALUATION
On Dwelling House $5000 $20,000
On Barn $800 $1200
The Applicant will answer the following questions, and sign the same, as a description of the premises on which the Insurance will be predicated.
1.Building—Is it stone, brick, or wood? How many stories high? When situated? When built? Which part occupied by Applicant?
2. Walls—Are the division walls of brick? Are they entire? Do they rise above the roof?
3. Roof—What is it covered with? Are the gutters stone, metal or wood? Is there a scuttle and stairs to it?
4. Are the stoves and apparatus for using fire properly secured, and will you engage to keep them so?
5. Do the pipes enter a chimney? And is it built from the ground? Do pipes pass one or more wood partitions or floors? If so, how secured?
6. What fuel is used? And how are ashes disposed of?
7. What material is used for lighting?
8. For what purpose is the building used? How many tenants?
9. Distance and materials of other buildings, within 100 feet of the one to be insured? And how occupied?
10. What other insurance is there upon the property, and at what office? Has this Company any other Insurance within 100 feet of this risk?
11. Is the property mortgaged? And to what amount? Is there any insurance by the mortgage?
12. Is there any other party interested in the property?
13. Has the building a lightning rod? If so, is it on the old or new plan?
“Arlington”
1 Dwelling of Brick, main building two stories high, and wings one story. In Alexa. Co, Va, built about the year 1820. All occupied by applicant. 1 The Barn is of brisk, one story high, with a stone basement. 3 The main building of the Mansion House is covered with Slate and the wings with gravel. 3 The Barn is covd. with gravel. 3 The gutters are metal. 2 The division walls are of brick. 3 There is not a scuttle in the roof of the dwelling. 3 The Barn has a Cupola from wh. access to the roof is easy. 5 Pipes enter chimney. 5 Chimnies built from the ground. 5 No wood partitions. 4 Stoves and warming apparatus well secured 6 Wood & coal are used for fuel. 6 Ashes are put out a safe distance. 7 Burning fluids, or candles, or Kerosene Oil, or Gas are permitted. 8 Dwelling House. One Tenant. 9 A one story brick Kitchen & a one story brick Store House, both covd. with wood. 9 The one standing West of the Dwelling on a line with the north line thereof, both distant 44 feet. 10 $5000 by the “Home” Ins. Co. 10 No other risk within 100 feet 10 No other Ins. on the Barn. 11 Property unencumbered. 13 Barn has a lightning rod. 13 Dwelling has also. 13 New plan. 9 Barn has a cattle shed about 40 feet south east, and a waggon shed about 100 feet south; otherwise detached.
And the said applicant hereby covenants and agrees to and with said Company, that the foregoing is a just, full and true exposition of all the facts and circumstances in regard to the condition, situation, value and risk of the property to be insured, so far as the same are known to the applicant and are material to the risk.
Dated October 17th 1859
R E Lee Applicant
For 1 year at 40 cents
“ 1 “ at 80 “ [Make a diagram of the premises on the other side of this sheet.]
