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( i 1Ur IUtl IU— 7-�i1 A COUNTY ADMIN.— <br />Pr <br />�°.. � �C_ ertificate:ot Real Estate Value <br />(312 4(34 456s;U 3 <br />Number <br />yes a. k.Mr �kR 'rr;� a,F sn tCZF"AS <br />r/ a.�.,,Y`r�.-•s.so�.. <br />i4K1,3 ,'es7':'<is�_ - <br />�.+-: - _�.- -,',-..��."_ ., '.s ;-�_ i:.� �;:' '7ti3�r»1�"1+*.s.•" .Y_.:..:.)i�! 4'-Yy ':S".�� ;�"skss <<�- -.-�'i <br />- tC if a mortgage o, contract for deed is not a variable market rate but the terms of payment are scheduled to change on a fixed date. fill in its fine number from above, the - <br />month and year of thechange. and what it will change to (pr attach 3 copies of payment scheoule): _4_ _ -,1,) irvr;.n � ��: "-:. r, `• �- - <br />Fill out schedule B on the back of this sheet to determine the amount `of your deed tax' <br />I declare that ;he inforrnat ion titled in on this form is true, correct and comPiete to the test o` my know'edge and belief. <br />_ <br />Print or type name of perscn signing lhis form _ _ _ ; . Signature ., _ -, -. Listed Phone Numbe, i Date <br />r�l/A/Alk-- <br />VC777- _..,j '/f B io! P!at—Parcel 1:n` " B'. —1` rt`.1- 4�=..zoo r: �T <br />r Le ar2menf o! Aev� t �v Jye iy <br />f� _„.3_ <br />