B91 L5 7-8-9-10-11-12SL q1 X01f 6—
TO BE FILED
Real Estate Transfer Statement
FORM
WITH REGISTER
This Statement is Confidential — for Tax Officials Only
521
OF DEEDS
• Read instructions on reverse side
Section
• THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 THROUGH 19 ARE PROPERLY COMPLETED •
COUNTY ASSESSOR'S USE ONLY
Block
County Name
County No.
Sales No.
Location LD,
Property Type
(1) ❑ Single Family (4) ❑ Commercial (7) ❑ Agricultural (Total
No. of Acres )
(2)Multi Family (5) Industrial (8) Mineral Interests
❑ ❑ ❑
1 Date of
2 Date of Deed
Home Sites Recreational Other 0
jale
No. of Stories
(3) (6) (9)
❑ ❑Cabins eta
Month Day Year sly
Month Da Year
3 Grantor's Name, Address, and Telephone
4 Grantee's Name, Address and Telephone
Grantor's
ff (Seller) jy
Grantee's Name (Buye
Street or Other Mailing Address
Street or Other Mailing jdlir s ky
2326 Phelps
C
City Fremont State
P
Zip Code
City
State / f{ Code
(�,LVt`�,J
' 68025
RCN
$ t 00
(c� U
Telephone Number
Telephon Nu b r
A 9191
5 Federal Employer Identification or Social Security Number
47-6006106De
6 Type o eed�
Depreciation Study Reason No.
❑ YES ❑ NO
of Grantee(s) (if more than two, attach list)
Type
Total Acres/Lots
7 Type of Transfer .rfy�
El Sale El Gift 1:1 Exchange El Foreclosure El Satisfaction of Contract �c�,,Dther (explain)
8 Ownership Transferred in Full (if no, explain) 9 Was sale between relativ s? (if yes, state relationship)
YES El NO El YES f�NO
10 If the reat estate was transferred for nominal 11 Was mortgage assumed? (if yes, state amount and interest rate)
consideration, what is the current market value? $ ❑ YES NO $ %
12 Does thisconveyance divide a�cturrant
❑ 13 Was sale throng real estate agent? 14 Was real estate purchased for same use? (if no, explain)
parcel of land? YES y NO El YES nNO
15 Address of Property City State t v .(U' de
18 Legal Description 0Q w� �eV tt ! Ot��t j A p./ 1t k ('_ I� �o �,
-ET O l _L /
17 Total purchase price including any liabilities assumed ............:. ................................... 17 $. :00
18 Was non real property included in purchase? ❑ Yes ❑ No (If yes, enter amount and attach itemized list) ............ 18 $ 100
19 Adjusted purchaseKice paid for real estate (line 17 minus line 18) ............................... 19 $ --- 00
Un p alt s of perjury, I declare that 1 have exa load this statement and that it is, to the best of my knowledge and belief,
r
true and corr, d hat I am duly authori his
sign tment.
sign 1�11 -
Signature : itie Date
hereI.
REGISTER OF DEEDS' USE ONLY
20 Date Deed Recorded
Month Day Year
21 Value of Stamp or Exempt Number
$
22 Deed Book 23
Deed Page
COUNTY ASSESSOR'S USE ONLY
24 Parcel Identification
28 Agricultural Land
Township
Section
Quar.
Subdivision
Block
Parcel Number
LVG
No: of Acres
LVG,
No. of Acres
25 Improved Parcels
Arch Type
Occ. Code
CC
Quality
No. of Stories
Story Height
Floor Area
Basement
Finish
Garage Stall
Garage Type
Year Built
Modernization/Rehab
Miscellaneous
RCN
$ t 00
Miscellaneous
Depreciation Study Reason No.
❑ YES ❑ NO
Does land adjoin current operating irr.
unit?
❑ YES ❑ NO
Type
Total Acres/Lots
28 Platted Lots
Zoning
Irreg.
Front
Depth
29 Land Value ... .... . . .
29
t
$ t 00
Lot Size
Street Improvement
Site Improvement
30 Improvement value
30
1
$ , 00
27Should this sale be used in an assessment/sales if no, give nonuseabie sales code
31 Total value (line 29 plus
QUIT CLAIM DEED
MARY BETH WRIGHT, a widow not remarried, personally and as
personal representative of the estate of Maxon S. McQuarrie,
MARGARET MC GILL and DON MC GILL, wife and husband, JOHN D. MC
QUARRIE and BILLIE MAY MCQUARRIE, husband and wife, and ANN
CARLSON and ROBERT E. CARLSON, wife and husband, being all of
the children and all of the persons that would have inherited any
properties either by Last Will and Testament or by intestacy, from
George C. McQuarrie or Maxon S. McQuarrie who died respectively on
June 10, 1958 and September 28,1988.
In consideration of NO CONSIDERATION - CONVEY TO
The following described real. estate: Cemetery lots, described as
Lot 5 in Block 91, spaces 7 through 12, City of Blair, Washington,
County, Nebraska
Don McGill
-YVI 1-1� - (3, J -L C(_) t1,L1Zj
Mary B th Wright, peAonally
and as personal representative
of the Maxon S. McQuarrie Estate
Billie Matte McQuarrie
Marg et McGill
Ann Carlson hn D. c u rri
ober E. Carlson
STATE OF NEBRASKA - DODGE COUNTY The foregoing instrument was
acknowledged before me on January :.2�1989 by Ann Car , MRIARY'Stale01Reb"sk'
Robert E. Carlson. G ERR,MCILHERAP!
J*71GAV Camm. fxp. APni 1, 1'
STATE OF NEBRASKA - DOUGLAS COUNTY Nota y'Public
The foregoing instrument was acknowledged before me on ,
1989 by Mary Beth Wrigh
IIEMp1'! M�NCOORRfj: C/
Ab oe,�. /Z*w
bRAWMA- ary b i
STATE OF COLORADO - S?F
2
The foregoing instrument was acknowledged before me on
1989 by John D. McQuarrie and Billie Mar_McQuarrie.
Notary euniic
STATE OF NEBRASKA - KNOX COUNTY ilCC/JrC/iLc,c< C tetTt_ 11:-7«: !� j
The foregoing instrument was acknowledged before me on
1.989 bv Mar aret McGill and Don McGill.
CENfAAI MOTAAY•Stale M mob 7 _
LW17HEAINE R. NALYia1DE
MyCwArt Notary Public
----------------------------------------------------------------
STATE OF NEBRASKA - WASHINGTON COUNTY -
Filed for record and entered in Numerical Index on
1989 at O'clock M. and recorded in Deed Record
Page
Washington County Clerk
City of Blair.
218 South 16th
Blair, Nebraska 68008
402-426-4191
February 1, 1989
Mrs. Robert Carlson
2326 Phelps
Fremont, Nebraska 68025
Dear Mrs. Carlson,
The City of Blair wishes to thank you and your family members for
the kind offer of the return of unused cemetery lots. The City will
accept the spaces and after conferring with our City Attorney you will
need to deed the spaces back to the City with a Quit Claim Deed.
Thank You again for the gift. Our records indicate the unused spaces
are & 7 thru 12, Blk 91 Lot 5.
Sincerely,
Patrick N. Long
Cemetery Sexton
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