1668 Nebraska St
Fee Paid:
$15.00
Date:
/0 -Ie; -em
Permit to Move Building or Demolish Structure
Owner
Name: E>V\e~t- rndeA6tV\
Address: I (Ao ~ Ne)ylJ)/~b~ Sf:
6Wi,v 1 1\ E Io~
Contractor
Name: ~~V\ ~tMl\cl; ~
Address: (?J::ll'J.. LLJ ~~ ~
~\j j r\ [ ~)KtJO
I
The above describ"ed person is hereby granted a permit to (Move) or ~~ a
15><\1-
building'~feet long, and Rfeet high, now located on /fcfuP flQj)tu.A~ SI"
City of Blair, Nebraska, to be finally located on
~ ~~ to be done on ID-26- f-b and shall take
. The (Move) or
~ 2- hours. The
route to be taken in the removal thereof is as follows: (Here designate the names and
numbers of the streets, alleys, or public grounds to be crossed):
"
The removal thereof shall be under the direction of the Street Commissioner and the
Director of Public Works. The building is to be used for
purposes.
A statement that all taxes and special assessments on the building to be moved or
demolished and on the land from which it is to be moved or demolished have been fully
paid was received if - / 3- Dt and is attached. A corporate surety bond or two (2)
personal sureties to pay all damages that may be sustained to. any property, public or
private, and including curbs, paving, manholes, public utility lines and pipes, by reason of
the moving or demolishing of such building was received on
and is attached.
City Administrator
RRYMOND C. HRNSEN 1911.1980
RICHRRD F, HRNSEN, CPCU, RRI
PRESIDENT
JOHN RBBOTT
SRLES ASSOCIATE
Hansen Agency, Inc.
October 5, 2000
TO: Whom it May Concern
City of Blair
Blair, Nebraska 68008
RE: Ernest Andersen
H000124687
This is to confirm that no coverage exists on the structure, 15x12 frame, located at
the rear of the property at 1668 Nebraska Street, Blair, Nebraska, owned by the
captioned. The building has no value and is, therefore, not insurable.
It is understood that this structure will be demolished, and the above statement is a
requirement for the permit to be issued.
If you have any questions, please feel free to contact us.
Sincerely,
H,N5ENA--,NCY, INC,
(/ =::~
RiC:h-Jd F. Hansen, CPCU, AAI
RFH/mkc
1636 Washington St. Blair, Nebraska 68008 (402) 426-2167 FAX (402) 426-2157
1A
Nebraska Homestead Exemption Application
or Certification of Status
. Nebraska Schedule I -Income Statement must be filed with this form
. Read instructions on reverse side
PLEASE DO NOT WRITE INTHIS SPACE
FORM
c
458
A..
FILE WITH YOUR COUNTY ASSESSOR AFTER APRIL 1
AND ON OR BEFORE JUNE 30
PLEASE TYPE OR PRINT
County Number
APPLICANT'S NAME AND ADDRESS
County
Applicant's Social Security No.
Applicant's Year of Birth
Spouse's Social Security No.
Spouse's Year of Birth
N
N
o
() Legal description of homestead or location and physical description of mobile home Filing Status (Ovals must be filled in completely. Example: _)
13 or residence on leased land:
c::::> Single c::::> Married or Closely Related
If you were widowed or divorced since January 1 last year, please
answer the following:
Spouse's Name:
Date of Death: Date of Final Decree:
1 Do you currently own and occupy this property? c::::> YES c::::> NO
2 If you are currently residing in a nursing home,
please answer these questions:
Have the household furnishings been removed
from your home? c::::> YES c::::> NO
Is the house currently occupied by another
person?
If Yes, who is residing there?
3 If this property is owned by a trust, are you residing
on this homestead as a beneficiary under the c::::> YES c::::> NO
trust instrument?
4 If you received a homestead exemption last year,
is the preprinted information on this form complete
and correct (names, social security numbers,
birth date, marital status, exemption category,
other owner/occupants, etc.)?
If No, please enter correct information.
OTHER OWNERS WHO OCCUpy THE HOMESTEAD (attach list if needed)
· Nebraska Schedule I -Income Statement must be filed for each owner/occupant (do not repeat applicant and spouse)
Name Relationship to Applicant Social Security Number
c::::> YES c::::> NO
HOMESTEAD EXEMPTION CATEGORIES
. Nebraska Schedule I must be filed for all categories except No.5
. Read instructions on reverse side for specific requirements
(1) c::::> Qualified owner occupants age 65 and over
(2) c::::> Veterans disabled by a non-service-connected accident or illness
(annual certification required - Form 458B or VA certification)
(3) c::::> Disabled individuals (see instructions for certification
requirement)
(4) c::::> Veterans drawing compensation from the Department of
Veterans' Affairs because of 100% disability that was service-
connected, or the unremarried widow(er) (see instructions for
certification requirement)
(5) c::::> The value of a home substantially contributed to by the
Department of Veterans' Affairs (annual VA certification
required)
c::::> YES c::::> NO
sign
here ~ Signature of Applicant
Under penalties of law, I declare that I have examined this form and that it is, to the best of my knowledge and belief, true and correct.
I also declare that I am entitled to the Nebraska homestead exemption and have not applied for exemption elsewhere in the state.
Date
Telephone Number
FOR COUNTY ASSESSOR'S USE ONLY
Parcel or Location Identification Number
Tax District Number
Actual Value of the Homestead Property as of January 1
Veteran's Service Dates
o Service Dates Beginning
,19 _ and Ending
,19
. 0 APPROVED
COMMENTS:
o DISAPPROVED
Date Received by the Assessor ~ Signature of County Assessor Date
Nebraska Department of Revenue Authorized by Sections 77.3510 and 77-3528
Form No. 2-539.1983 Rev. 2-2000 Supersedes 2-539.1983 R~v. 2.1999
FILE THE WHITE AND CANARY COPIES WITH YOUR COUNTY ASSESSOR AFTER APRIL 1 AND ON OR BEFORE JUNE 30
Printed with soy ink on recycled paper RETAIN THE PINK COPY FOR YOUR RECORDS
TO Bf FILED
WITH COUNTY
ASSESSOR
Applicant's Name as Shown on, Forf1\458
NEBRASKA SCHEDULE I -Income Statement
. Attach this schedule to Nebraska Homestead Exemption Application
or Certification of Status, Form 458
. Read instructions careful!
FORM
458
This Income Statement is filed for (select one only, fill in oval completely, example: _ ):
C) Applicant C) Applicant & Spouse C) Spouse C) Other Owner/Occupant
Spou~e's or Other Owner/Oc;:cupant's Name
· If you filed a 1999 federal income tax return, complete only Part II
Household Income: Janua 1 throu h December 31 1999
1 Wages and salaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . 1 $
2 Social security retirementincome~ If none, explain
2
3 Tier I railroad retirement income
5 IRA distributions
5a
4b Taxable amount
5b Taxable amount
3
.......... 4b
5b
4 Total pensions and annuities 4a
6 Tax exempt interest and dividends (must include all state and local bond income) ............. 6
7 Taxable interest and dividends .................................................... 7
8 Other income or adjustments (from line G, Worksheet A on reverse side of white copy) . . . . . . . .
9 TOTAL OF LINES 1 THROUGH 8 .................................................
MEDICAL AND DENTAL EXPENSES - Caution: Do not include ex enses reimbursed b insurance or
10a Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . . . .. 10a
10b Multiply line 9 above by 4% (.04) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Db
1 Oc Subtract line 1 Ob from line 10a. If line 10b is more than line 1 Oa enter -0- ................... 10c
11 HOUSEHOLD INCOME line 9 minus line 10c ............................. ......... 11
PART II - For Applicants Who a 1999 Federal Income Tax Return
. If you did not ,file a 1999 federal income tax return, please complete only Part I and Worksheet A.
Household Income: Janua 1 throu h December 31,1999
1 Federal adjusted gross income (AGI) from line 33, Federal Form 1040; line 18,
Form 1040A; line 4, Form 1 040EZ; or iine H, TeleFile Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Social security retirement income (see instructions for Part II, line 2) . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tier I railroad retirement income (see instructions for Part II, line 3) . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Nebraska adjustments increasing federal AGI (from line 12, Form 1040N). . . . . . . . . .. . . . . . . . .. 4
5 Income from Nebraska obligations (from line 40b, Schedule I, Form 1040N) . . . . . . . . . . . . . . . . .. 5
6 TOTAL OF LINES 1 THROUGH 5 .................................................. 6
MEDICAL AND DENTAL EXPENSES - CAUTION: Do not include expenses reimbursed by insurance or paid by others
7a Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . . . . .. 7a
7b Multiply line 6, Part II, above by 4% (.04). . . . . . . . . . . . . . . . . . . . . . . . .. 7b
7c Subtract line 7b from line 7a. If line 7b is more than line 7a enter -0- ........................ 7c
8 HOUSEHOLD INCOME line 6 minus line 7c ......................................... 8
Under penalties qf law, I declare that I have examined this schedule, and that it IS, to the best of my knowledge and belief, correct and complete.
sign ,
here ~ Signature of Person Whose Income is Shown
~ (Spouse's Signature if Income Included)
Date
Daytime Phone
Nebraska Department of Revenue
Form No. 2-655-1994 Rev. 2-2000 Supersedes 2.655-1994 Rev. 2-1999
FILE FORM 458 AND THIS SCHEDULE WITH YOUR COUNTY ASSESSOR AFTER APRIL 1 AND ON OR BEFORE JUNE 30
RETAIN CANARY COPY FOR YOUR RECORDS
Printed with soy ink on recycled paper
Authorized by Section 77-3510 and 77-3528