B94 L9 G2-3OTHE DEED WILL NUI tat.
29 Value of .4Ya,mp oy Exempt„Number._
d
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-
COUNTY ASSESSOR'S USE ONLY
6 Type of Deed
r r u.¢w ( '
1�
24 Parcel Identification
County Name
County No!
Sales No.
Location I!D.
Property Type
(1) ❑ Single Family (4) [:]Commercial (7) ❑Agricultural (Total
9 Was sale between relatives? (if yes, state relationship)
�❑ YES ❑' NO
LVG
No. of Acres-- )
A
No. of Acres
(2) ❑ Multi Family (5) [:]Industrial (8) ❑Mineral Interests
1 Date of Sale
2 Date of Deed
Recreational
(3) ❑ Home Sites (6) ❑(Cabins, etc.) (9) ❑Other
Month Dayl c'!
_
Year
'5D41
Month Day Year
Telephone
4 Grantees Name, Address, and Telephone
3 Grantor's Name, Address, and
❑ YESNO
❑ NO
Name (Seller)
t> S i i e � � �''i; (o e�§ ` t.
Grantee's Name (Buyer)
.:'<£ `
?..
'w b1'�
gGrantor's
. > 3 e +.
3 Y� 3
5 n
Street or O=cher Mailing Address
Street or Other Mailing Address
17 Total purchaseLprice including any liabilities assumed...........' .....................:...:....
17
$ x `, moi,
ity-I ' tate Zip Code
�
'City
�x
'fit
Staate Zip Code
.
�- ?tt �I2� b CL.t9 yj.
�:.18V.,
rn.,, �e
Telephone Ngmberm
Telephone Number
100
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.
20 Date Deed Recorded'. ,
rr
Month °-�`' Dag Year
29 Value of .4Ya,mp oy Exempt„Number._
d
�,� Cox' C_��.� 4
22 'Deed B ._oyt
5 Federal Employer Identification or Social Security Number
°$ ' a
6 Type of Deed
r r u.¢w ( '
1�
24 Parcel Identification
O3 r .r 1..
of Grantees (if more than two, attach list) 4
..r , .=
Section
7 Type.of Transfer : -
❑ Sale ❑ Gift [:]Exchange ❑ Foreclosure ❑Satisfaction of Contract ❑ Other (explain)
Subdivision
8 Ownership Transferred in Full (if no, explain)
9 Was sale between relatives? (if yes, state relationship)
�❑ YES ❑' NO
LVG
❑ YES ❑ NO
A
No. of Acres
10 If the real estate was transferred for nominal.
❑.1,r
11 Was mortgage assumed? (if yes, state amount and interest rate)
s❑ NO
consideration, what is the current market value? $
YES $
io
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)
'.YES
No. of Stories
parcel of land? ❑ YES NO
❑ YESNO
❑ NO
15'Acidress of Property .r City State Zip Code
Floor Area
Basement
96 Legal Description`
17 Total purchaseLprice including any liabilities assumed...........' .....................:...:....
17
$ x `, moi,
00
I
18 Was non real property included in purchase? El Yes L! No (if yes, enter amount and attach itemized list) ..: ;....
18
$
00
19 Adjusted purchase price paid for real estate (line 17 minus line 18).......' . _
19
$ j" `'''
100
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.
Miscellaneous
k
signi ea .. C 'W _'`_ : fix gar f', f
Signature p Tale Date
here —_
Total Acres/Lots
f— �cr�orco ne —inc—lee nen v
1
20 Date Deed Recorded'. ,
rr
Month °-�`' Dag Year
29 Value of .4Ya,mp oy Exempt„Number._
d
�,� Cox' C_��.� 4
22 'Deed B ._oyt
�
23 Deed Paye
P 9
01 COUNTY ASSE OR'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
o.
Miscellaneous
Depreciati n Study Reason -00
❑ YES [:]NO
Does land adjoin current operating
unit? 11
❑ YES ❑ NO
Irr. Type
Total Acres/Lots
26 Platted Lots
Zoning
Irreg.
Front
Depth ,
29 Land value ..........
29
$ 100
Lot Size
Street Improvement
Site Improvement
30 Improvement value .....
30
$-00
27 Should this sale be used in an assessment/sales If no, give nonuseable sales code
ratio study? YES ❑ NO
31 Total value (line 29 plus
line 30 . . . . . . . . .
31
$ 00
Nebraska Department of Revenue Form No. 2-146-67 Rev. 10-85
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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