B91 L5 G7-8-9-10-11-12KEEP ME
This is your legal description for your Real Estate,
and you will always have it for futu� use
Spaces 7 through 12 Lot 5 Blk 91
Blair Cemetery
City of Blair, Nebraska
CHARLOTTE L. PETERSEN
County Clerk & Register of Deeds
Blair, Nebraska 68008
68025
Telephone Number
Telephone Number
t
5 Federal Employer Identification or Social Security Number
76
6 Type of Deed
of Grantee(s) (if more than two, attach list)
Parcel Identification 28 Agricultural Land
7 Type of Transfer
Section
❑ Sale ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑'Other (explain)
LVG No. of Acres
3 OwnershipTransferred in Full (if no, explain)
9 Was sale between relatives? (if yes, state relationship)
Improved Parcels
❑ YES ❑ NO
❑ YES ❑ NO
Arch Type
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
13 Was sale through a real estate agent?
14 Was real estate purchased for same use? (if no, explain)
;
parcel of land? ❑ YES ❑ NO
❑ YES r❑ NOI
Garage Stall
15 Address of Property ', City State
Zip Code
16 Legal Description
--
Year Built
17 Total purchase price including any liabilities assumed ............. ........
17
$ 100
18 Was non real property included in purchase? ❑ Yes ❑` No (If yes, enter amount and attach itemized list) ............
18
$ :00
19 Adjusted purchase price paid for real estate (line 17 minus line 1$) ....''.................... < ....:.........
19
$ :00
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
Signature Title
r
Date
REGISTER OF DEEDS' USE ONLY
u�
20 Date Deed Recorded r 21 lu
Vae of Sta �p or E empt Number 22 Deed Book 23 Deed Pa e
Month Dam') Year $,� �J
_
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
_
$ 00
Miscellaneous
Depreciation Study Reason No.
Does land adjoin current operating Irr.
Type
Total Acres/Lots
❑ YES ❑ NO
unit?
❑ YES ❑ NO
[26 Platted Lots
Zoning
Irreg.
Front
Depth
29 Land Value. . . . .
2]
$
00
Lot Size
Street Improvement
Site Improvement
_
T
30 Improvement value
30
$
i 00
27Should this sale
be used in an
assessment/sales If no; give nonuseable sales code
31 Total value (line 29 plus
ratio study?
❑ YES ❑ NO
line 30)
31
$
00
iVenraSKa department OT Revenue corm NO. Z-l4b-b/- Hev. lU-Sb AUtnonzed by Sechon /b-214, //-132(, //-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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