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<br />Boor ' R race246 <br />tt. <br />DESCRIPTION AND LOCATION' <br />V A L U E S <br />No. <br />OF PROPERTY 1 <br />Speciry A-BviMv.g B-Persotul Pmpe <br />ty <br />Actual Cash Value <br />emen <br />Repla <br />t C. <br />st <br />Thu Space lar Rniaz <br />Organization <br />Use <br />l <br />Wh <br />Appli <br />en <br />cabl <br />e <br />Ii <br />1 <br />1 <br />I <br />t <br />1 <br />I <br />i <br />TO WHOM IT MAY CONCERN:- <br />Values for this "Statement of Values" <br />Lee County North Carolin <br />by <br />fisting of pages attached hereto were prepared for <br />Lee Coun <br />.tame of Insured <br />uorated <br />Childress-Roberts <br />1--c of person twlth title) or corporation preparing "Yaluei' <br />P. C. Box 1247 <br />1722 South Horner Boulevard ;Sanford North Carolina 2733G <br />Street Address - I Ci[Y State <br />and are hereby filed with the Rating Organization to obtain an insurance rate. All values submitted <br />are correct to the best of my knowledge and belief. 1 <br />I <br />Form MLB-_4 (Ed. 5-69) Page 2 of r Board of Co=issioners <br />NORTH CAROLINA, LEc GOUNTY <br />Dated July `J 73 <br />Presented for re"istration on the'./a-q.day 19.__._ <br />of. 197 at r~M. <br />Signed Insured <br />recorded n Book------ -----.-_Page- 1 <br />Pattie W. McGilvary, Register of Deeds <br />Title (or authority to sign) <br />- - - - - <br />