B61 L2 G4-5-6.20610 390
WASHINGTON COUNTY, STATE OF NEBRASKA
RECORDED (.17j / L r t ,J 1, (0Y. AT/i! I_�.?. M.
BOOK PAGE(S)
��esn vn� CL. rn"Lrizt o
REGISTER OF DEEDS
321
NEBRASKA DOCUMENTARY
STAMP TAX
1.1 BOOS
/G? By
Date
QUITCLAIM DEED
�._.
2008 AUG 21 Phi 1: I
WASHINGTON COUNTY
REGISTER OF DEEDS
I2 NE
CORINNE D. DeJARNETT, a Single Person, Grantor, whether one or more, in consideration
of ONE DOLLAR ($1.00) and other valuable consideration, receipt of which is hereby
acknowledged, quitclaims and conveys to CITY OF BLAIR, NEBRASKA, Grantee, the following
described real estate (as defined in Neb. Rev. Stat. § 76 -201) in Washington County, Nebraska:
Grave Spaces 4, 5 and 6 in Lot 2, Block 61 of the Blair
Cemetery located in the Northeast Quarter of the Northeast
Quarter (NE1 /4 NE1 /4) of Section Twelve (12), Township
Eighteen (18) North, Range Eleven (11), East of the 6th
P.M., Washington County, Nebraska.
Executed: July 30, 1999.
GEN RE k la NM-ScatT bgoTska
EDMOND E. MY Comm t P MATO 10 1
p -
ORINNE D. DeJARNETT
STATE OF NEBRASKA
COUNTY OF WASHINGTON
Th foregoing instrument was acknowledged before me on July 30, 1 n no l CORINNE D
g my J , 1ll t y �iJl`t t L D.
DeJARNETT.
321
Recorded
General
Numerical
Photostat .�._
Proofed
Scanned
TO BE FILED
WITH REGISTER
OF DEEDS
THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 -25 ARE ACCURATELY COMPLETED
1 County Name 2 County Number 3 Date of Sale 4 Date of Deed
Mo. Day Yr Mo. Day Yr.
1 5 Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print)
Grantor's Name (Seller) Grantee's Name (Buyer)
Street or Other Mailing Address
City
Telephone Number
State
( ) ( )
7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home.
(A) Status
(1)0 Improved (1)0 Single Family (4) ❑ Industrial
(20 Unimproved (2)0 Multi - Family (5) ❑ Agricultural
(3)❑ IOLL (3)❑ Commercial
8 Type of Deed
❑ Warranty ❑ Sheriff ❑ Executor ❑ Mineral
❑ Quit Claim ❑ Conservator ❑ Partition ❑ Trust
10 Type of Transfer
❑ Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure
11 Ownership Transferred in Full (if No, explain division)
❑ YES ❑ NO
13 Was sale between relatives? (If Yes, check appropriate box)
❑ YES ❑ NO ❑ Spouse
16 Does this conveyance divide a current parcel of land? 17
❑ YES NO OYES ❑ NO
18 Address of Property
20 Legal Description
26 Date Deed Recorded
Mo. Day Yr
Nebraska Department of Property Assessment & Taxation
Form No. 2- 146 -67 Rev. 12 -00 Supersedes 2- 146 -67 Rev. 9 -94
S
%al y printed with soy ink on recycled paper
Real Estate Transfer Statement
REGISTER OF DEEDS' USE ONLY
27 Value of Stamp or Exempt Number
• Read instructions on reverse side
Street or Other Mailing Address
Zip Code City
Telephone Number
(B) Property Type
(6) ❑ Recreational (8) ❑ Mineral Interests- (9) ❑ State Assessed
(7) [2] Mineral Interests- Producing (10) ❑ Exempt
Nonproducing
❑ Cemetery
❑ Other
❑ Satisfaction of Contract
❑ Life Estate ❑ Other (explain)
12 Was real estate purchased for same use? (if No, state Intended use)
❑ YES ❑ NO
❑ Parents and Child ❑ Family Corporation or Partnership
❑ Grandparents and Grandchild ❑ Brothers and Sisters ❑ Aunt or Uncle to Niece or Nephew ❑ Other
14 If the real estate was transferred for nominal consideration, what is the current market l 15 Was mortgage assumed? If Yes, state amount and interest rate.
value? ( ❑ YES ❑ NO $
Was sale through a real estate agent? (if Yes, name of agent)
19 Name and Address of Person to Whom Tax Statement Should be Sent
21 If agricultural, list total number of acreq
22 Total purchase price, including any liabilities assumed 22 $
23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) 23 $
24 Adjusted purchase price paid for real estate (line 22 minus line 23) 24;: $
Under penalties of law, 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.
25
ig n Print or Type Name of Grantee or Authorized Representative Telephone Number
h ere 0 ' Signature of Grantee or Authorized Representative Title Date
28 Deed Book
29 Deed Page
State
FORM
521
Zip Code
(C)
(1) ❑ Mobile Home
FOR NDR USE ONLI1
30
Authorized by Sections 76 -214, 77 -1327, R.R.S. 1943
NEBRASKA DEPARTMENT OF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy
STATE OF NEBRASKA
COUNTY OF WASHINGTON
) :ss:
AFFIDAVIT
CORINNE D. DeJARNETT, being first duly sworn on oath, deposes and says that she and
Tollie L. DeJarnett were wife and husband, and that she is the surviving spouse of Tollie L.
DeJarnett who died , 1999, and that a copy of the Certificate of Death for Tollie
L. DeJarnett is attached hereto, marked Exhibit "A" and by this reference made a part hereof.
Affiant further deposes and says that Tollie L. DeJarnett and Corinne D. DeJarnett, husband
and wife, were the owners in joint tenancy of the following described real estate, to -wit:
Grave Spaces 4, 5 and 6 in Lot 2, Block 61 of the Blair Cemetery located in the
Northeast Quarter of the Northeast Quarter (NE1 /4 NE1 /4) of Section Twelve (12),
Township Eighteen (18) North, Range Eleven (11), East of the 6 P.M., Washington
County, Nebraska
and that, upon the death of the said Tollie L. DeJarnett, the undersigned, Corinne D. DeJarnett,
became the sole owner of said real estate by operation of law.
Dated this 30 day of July, 1999.
( CORINNE D. DeJARNE VV
SUBSCRIBED AND SWORN to before me this 30 day of July, 1999.
GENERAL. NOTARY•Slate of Nebraska
EDMOND E. TALBOT
My Comm. Exp. March 10, 2001
r�
I-
, �u �1,v,4v,,pui! ..li �41'a�amiill;,41�1 e v,A ill l'�lJ'll1.l�Li1l1➢,�f�koiLl.a�l n�ll�1�I11� ��V 1 ,�1_.��l�i«�11� -Ak l►� ll� IaI I�,AvAI��d111.�1��?l�l 0)
Toll
�� ._.
� L. and/or Corinne D. Dejarnett
This is to Certify That
6003 M 43th St., Omaha, �1 63104
., of , has this day purchased of the CITY OF BLAIR, Was
in ton County, and State of Nebraska, the following piece of land, situated in the Northeast
g
5 Quarter of the Northeast Quarter of Section Twelve, Township G Eighteen, n, ?
in North Range
Eleven, East, and more particularly described as follows, to -wi of the BLAIR CEMETERY,
Lot No. 2 Block No.
5 and that the said . . C.i.ty..of .51 ad r.,. NE
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 to hold unto the said Toll e L. and /or Corinne D. DeJarnett
5 le for the purpose of interment,
heirs and assigns, the above described premises in fee simple
under the regulations of the Council of said City, subject also to all rules and regulations
adopted from time to time by the Trustees of the Blair Cemetery Association. and caused
In Witness Whereof, the said
grantor hath set its
these presents to be signed by its Mayor and countersigned
2nd day of
(rat;
(- %/ Mayor.
5
(Seal)
Price of Lot $
WilaMENylararntm
375.00
by its Clerk at Fail-ads
November,
`,
p tanl eyn se City Clerk
Attest: ... ..�j : %::: '.: � =:� .... .
Verna R. Bull
Verf lor Number
or� l e, D.
To � rl
,o0
\E-
Account Number
0)67y) 3 635 4,LU .
1 do solemnly swear that the above account Is true and correct to the best of my knowledge.
Subscribed and sworn to before me this day of
Finance Committee Approval:
CITY OF BLAIR, NEBRASKA
DC4I,r R e+
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\k'2_
Description
�. oO) 3L9
19_
Claim Date
Voucher Number
Check Number
2q 3 00
City Clerk