1999-01-18 Concrete equipment co-11
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Telephone Number ( � �+ � I Telephone Number 4 � � b— , t
7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home.
(A) Status (B) Property Type (C)
(1) Improved (1) ❑ Single Family (4) ❑ Industrial (6) ❑ Recreational (8) ❑ Mineral Interests- (9) ❑ State Assessed (1) ❑ Mobile Home
(2) Unimproved (2) ® Mui i- Family (5) ❑ Agricultural M ❑ Mineral Interests- Producing (10) ❑ Exempt
(3)0 IOLL (3) Commercial Nonproducing
8 Type of Deed 9 Federal Employer Identification or Social Security Number(s) of
Warranty ❑ Sheriff ❑ Executor ❑ Mineral ❑ Cemetery ee(s) (if than two, attach list)
Quit Claim ❑ Conservator ❑ Partition ❑ Trust ❑ Other � 1 7° U T 3 q g 2
10 T pe of Transfer
Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain)
11 Ownership Transferred in Full (f No, explain division) 12 Was real estate purchased for same use? (if No, state intended use)
� Vf YES ❑ NO ❑ YES ❑ NO
Was sale between relatives? (If Yes, check appropr
❑ YES NO ❑ Spouse
❑ Parents and Child ❑ Family Corporation or Partnership
U Grandparents and Grandchild U Brothers and Sisters U Aunt or Uncle to Niece or Nephew U Other
14 If the real estate was transferred for nominal consideration, what is the current market I 15 Was mortgag med?. If Yes, state amount and interest rate.
value? ❑ YES NO $ %
16 Does this conveyance divide a current parcel of land? 17 Was sale Tr9ugh areal estate agent? (d Yes, name of agent)
❑ YES []NO []YES AND
18 Address of Propert}r \ and Address of Person to Whom Tax Statement Should be Sent
Add es; L � c t k�P N ♦ Ce WYi < h k{, -1 d. r ,
X37 /V• 3 r� 5
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20 Legal De s c ri pt i on i , , 61OCK 23 a .. 610
21 If agricultural, list total number of acres
22 Total purchase price, including any liabilities assumed ...................................................
22 $ d 0
23 Was nonreal property included in purchase? . [ ❑ NO (if Yes, enter amount and attach itemized list) ... 23
$
24 Adjusted purchase price paid for real estate line 22 minus line 23 24 j 0A
................. ..... ...
Under penalties of law, I declare that I have examined this statement and that it is, to the hest of my knowledge and belief, true and
correct, and that I am duly authorized to sig this statement
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Telephone Number
Title ate
REGISTER OF DEEDS' USE ONLY
FOR NDR USE ONL
26 Date De / gd Recorded
Mo. Day t Yr.
27 Value of Stamp or Exempt Number
$ -W ��-�72 °�
eed Book
28 D C 9,5 U ,5
29 Deed Page
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30
Nebraska Department of Revenue Form No. 2- 146-67 Rev. 9.94
Supersedes 2 -146 -67 Rev. 11 -92
NEBRASKA DEPARTMENT OF REVENUE — White Copy
Authorized by Sections 76- 214, 77 -1327, R.R.S. 1943
COUNT( ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy