Carlson Buybackt
October 7, 2022
Marcia Carlson
224 N. Logan St.
Fremont, NE 68025
Dear Ms. Carlson,
You purchased a cemetery grave space from the City of Blair in 1994 for the value of $250.00. If
you were to sell that lot back to the City of Blair, we would purchase it for $200.00.
The current value of a cemetery grave space today is $550.00. You could sell that lot to someone
for $550 or more, if you could find someone to purchase it from you. Therefore, the value of your
lot would depend on who you sold it to and what they were willing to pay for it.
Unfortunately, we have no way to give you a set value. Hopefully, the options above will provide
the required information to the Social Security Administration.
Feel free to contact me should you need anything additional. Thank you.
Sincerely,
Brenda Wheeler
City Clerk
218 SoOi 16th Strut • B104, NOWOOO 6MM • 402-426-4191 - Facet 402.426.4196 • E -mc c tC , nubs (Y9
Z'�1v.
— I Off_ aL 1 S--q
It
It.
6 , L
� lA,
0
��t0
0
cj
0
00,
Social Security Administration
Supplemental Security Income
Important Information
MARCIA. JOY CARLSON
224 N LOGAN ST
FREMONT, NE 68025
SOCIAL SECURITY
OLD MILL CENTRE
604 N 109TH CT
OMAHA NE 68154
Date: September 19, 2022
BNCA 22S2096A59182
Office Hours:
MON, TUE, THU, and FRI
9:00 AM -4:00 PM
WED 9:00 AM - 4:00 PM
Telephone: 866-716-8299
Extension: 28079
Time: 3:10 PM ET
Unit: WMR
On September 19, 2022, we talked with you and completed your application for
Supplemental Security Income (SSI). We have stored your application
electronically in our records. Attached is a summary of your statements for
your review.
What You Need To Do
® Review the application summary to ensure we recorded your statements
correctly.
® If you agree with all your statements, you may retain the application
summary for your records.
• If you disagree with •any of your statements, you should contact us
within 10 days after any
this notice to let us know.
w Mail or bring the information requested below along with this notice. If
you mail the information, please use the enclosed postage paid envelope.
See Next Page
22S2096A59182
09/19/2022
Important Reminder
Penalty of Perjury
You declared under penalty of perjury that you examined
on this form and it is true and correct to the best of your
were told that you could be liable under law for providing
Page 2 of 4
all the information
knowledge. You
false information.
2252096A59182
09/19/2022
Things We Need
Page 3 of 4
We need to see all of the items listed below. We will help you get anything.
you do not have.
We must see the original document(s) or a certified copy of the item(s)
unless otherwise indicated. When an original document or a copy certified
by the issuing agency is required, we cannot accept a photocopy or notarized
copy of the document. We will return the original document(s) or certified
copies to you. ^
• An exact copy of the trust, related documents and trust account
statements for July 2022 through September 2022
• Signed statement or contract to purchase burial spaces and r ler a
items showing their value and for whom held for July 2022 thro
----S-eptember 2022
• COPY OF YOUR TRUST SHOWING WHEN CREATED, WHO
FUNDED, THE ASSETS HELD IN THE TRUST ALONG WITH THEIR
VALUE, AND INCOME RECEIVED FROM THE TRUST SINCE JUL
• . Y 2022.
"f • VERIFICATION OF YOUR CEMETARY PLOT SHOWING
If We Do Not Hear From You
If you do not respond to our request for information or evidence or contact us
by October 19, 2022, we may deny your application for SSI. Even if you don't
have all of the information, we need to hear from you. We will help you get
anything you do not have.
Information About Medicaid
In many States, applying for SSI means you also are applying for Medicaid.
If we deny your SSI application, you cannot get Medicaid based on SSI.
Need more help?
I. Visit www.ssa.gov for fast, simple, and secure online service.
2. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm. If you
are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention
this letter when you call.
2252096A59182 Page 4 of 4
09/19/2022
3. You may also call your local office at 866-716-8299.
SOCIAL SECURITY
OLD MILL CENTRE
604 N 109TH CT
OMAHA. NE 68154
How are we doing? Go to www.ssa.gov/feedback to tell us.
If you have any questions, please contact us and have this notice with you,
it will help us serve you more quickly.
Manager
Enclosure(s):
Application Summary
Return Envelope
•5 7 l
CEMETERY DEED
This is to certify that MARCIA J. CARL.SON and/or
of FREMONT, NE has this day purchased of the CITY OF BLAIR,
Washington County, and State of Nebraska, the following piece of land,
situated in the Northeast Quarter of the Northeast Quarter of Section
Twelve, Township Eighteen, North Range Eleven, East, and more particularly
described as follows, to wit: Grave spaces) 6• Lot No,' 19
in Block No. 096 of the BLAIR CEMETERY, and that the said
CITY of BLAIR, NEBRASKA is the owner of the above described premises as laid
down on'the plat on file in the office of the Clerk of said City, to have and
t6 hold unto the said MARCIA J. CARLSON and/or
and assigns, the above described premises in fee simple for the purpose of
interment, under the regulation of the Council of said City, subject
also to all rules and regulations adopted frpm time to time
by the CITY OF BLAIR, NEBRASKA.
in Witness Whereof, the said grantor hath set its Seal and
caused these presents to be signed by its Mayor and countersigned
by,�Ws`s,-Cgerk, at Blair this 14 day of July A.D. 1994
Od 9``'�Ir
..........AL
9�yr+
,c1�i'Y tl�
'4'^ c "P�� Mayor
Price of.Loi. 250.00 At / ` lerk
STAYti dYPICCFU-^1NCMOFv7r•AI1RI0':QIrJ85��'
ikiU�N. tl�,El. Nra F7LFU POOPF,:4'Q}rG
NEERASIfA DOCUMENTARY
S�TA�t,MPT0
L?:iL11WN to
'11Pt7 YGP �a7, �-
1✓�"..CPRbFDiN POOiG
Dd O
AT , aTP CN
0
�� � ID "L'LL,^++/ -
CwIRYC
et<P�rr
yn
n � W
571