B81 L11 G5-6KEEP ME
TO BE FILED This is your legal description for your Real and 3tement FORM
WITH REGISTER you will always have it for future use. IffiCials Only
OF DEEDS Graves 5 and 6 Lot 11 B1 k 8 521
a THE DEED WILL Blair, Ne. Blair Cemetery 1 THROUGH 19 ARE PROPERLY COMPLETED
COUNTY
County Name Count City of Blair
`i
Property Type
I
(1) ❑ Single Family (4) ❑'' CHARLOTTE L. PETERSEN
(2)Multi Family (5) 1 VVUllry MUM IX nt:; IJICI VI LICCUJ
❑
,;.
2 Date of Deed
Blair, Nebraska 68008
23 Deed Page
3 Home Sites 6 ❑ Rec, O cabins may Year
(-) ❑
Month 6Day Year �• '
3 Grantor's Name, Address, and Telephone
4 Grantee's Name, Address, and Telephone
Grantor's Name (Seller)
Grantee's Name (Buyer)
1"
Wl� Gutachow and Alice
Block
Street or Other Mailing AddressStreet
or they Mailing Address
North t
1
City State ZipCode
City' State Zip Code
Bl 8,0„
.t
Telephone Number
Telephone Number
k y € 2x� .D 2
(402)f"
5' Federal Employer Identification or Social Securit Number
Tax
6 Type of Deed
lQuitclaim
of Grantee(s) (if more than two, attach list) I.D.
Deed
7 Type of Transfer
❑ Sale ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract 14 Other "(expla
8 Ownehip Transferred In Full (if no, explain) 9 Was sale between relatives? (if yes, state relationship)
YES ❑ NO 1 ❑ YES M NO
10 If the real 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 this conveyance divide a current 113 Was sale through a real estate agent? 14 Was real estate purchased for same use? (if no, explain)
[Iy
parcel of land? YES NO I ❑ YES 0 NO ye 8
15 Address of Property City State Zip Code
16 Legal Description
Gow,ity, Nebraska.
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 $ too
i
19 Adjusted purchase price paid for real estate (line 17 minus line 18) ..... ............................... 19 $ too
Under penalties of perjury, I declare that I have examined this statement and that it is, to the best of my knowledge and belief,
true and correct, and that I am duly authorized to sign this statement.
sign
hereIs' Signature Title. Date
REGISTER OF DEEDS' USE ONLY
20 Date Deed Recorded
Month Day` Y(
21 Value of Stamp or Exempt Number
$ V2 /1-1
22 Deed Book
23 Deed Page
COUNTY ASSESSOR'S USE ONLY
24 Parcel Identification
28 Agricultural Land
Township
Section
I Quar.
I 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
$ 00
Miscellaneous
Depreciation Study Reason No.
❑ YES ❑ NO
Does land adjoin current operating
unit?
❑ YES ❑ NO
hr. Type
Total Acres/Lots
26 Platted Lots
Zoning
Irreg.
Front
Depth
29 Land Value .
29
$ i 00
Lot Size
Street Improvement
Site Improvement
30 Improvement value
30
$ 00
27Should this sale be used in an assessment/sales If no, give nonuseable sales code
ratio study? 1, 1 ❑ YES ❑ NO
31 Total value (line 29 plus
I line 30)
31
r
$ 00
Nebraska' Department of Revenue Form No. 2-146-67- Rev. 10-85 Authorized by Section 16-214, //-1 32/, ii -1326 H.H.S. 1943
Supersedes `2 146-67 Rev. 11-79
COUNTY ASSESSOR -White and Canary Copies NEBRASKA DEPARTMENT OF REVENUE — Pink Copy GRANTEE — Goldenrod Copy
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