I the underwritten Cornelius Shawen, residing at Beaver Dam in the County of Loudoun do hereby declare for Assurance in the Mutual Assurance Society against Fire on buildings of the State of Virginia, established the 25th December, 1795, agreeable to the several Acts of the General Assembly of this State to wit:
My own building on my Plantation now occupied by myself situated between [illegible] and [illegible] in the County of Loudoun their dimensions, situaton and continuity to other buildings or wharves what the walls are built of, and what the buildings are covered with, are specified in the hereunto annexed description of the said buildings on the Plat, signed by me and the appraisers and each valued by them as appears by their Certificate hereunder, to wit:
The Mill House marked A, at
6,000 dollars, say six thousand dollars;
6,000, say six thousand Dollars in all.
I do hereby declare and affirm that I hold the above mentioned buildings with the land on which they stand in fee-simple, and that they are not, nor shall be, insured elsewhere, without giving thereof, agreeable to the policy that may idue to my name, upon the filing of this declaration, and provided the whole sum does not exceed four fifths of the verified value, and that I will abide by, observe, and adhere to the Constitution, Rules, and Regulations as are already established, or may hereafter be established by a majority of the insured present, in person, or by representatives, or by a majority of the property insured, represented, either by the persons themselves, or their proxy duly authorized, or their deputy as established by law, at the general meeting, to be held by the said Assurance Society. Witness my hand and seal, at Beaver Dam, this 30th day of August, 1803.
Cornelius Shawen
Seal, P.F. Marble, J.A.
We, the underwritten, being each of us house owners, declare and affirm that we have examined the above mentioned property of Shawen and that we are of opinion that it would cost in cash six thousand dollars to build the same, and is now (after the deduction of --- Dollars for decay or bad repair) actually worth six thousand Dollars in ready money, as above specified, to the best of our knowledge and belief, and he the said subscriber has acknowledged before us his above signature.
Residing in Loudoun
Anthony P..d
Elisha M...
[Signatures not legible]
Mill House three stories 40 by 54 feet covered with wood
Two pair Burr Stones
One pair Country [Stones]
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