1995-04-04 Memorial hospitalDuplicate Affidavits of this Pub lication
County Court L] Clerk of Dist. Court L J County Clerk Ll Sec. State 5
AFFIDAVIT OF PRINTER
STATE OF NEBRASKA
l C ' 1 , E ,`P!,
ss. �,
Washington County,
Rf �
1 1,.k'
Kenneth H. Rhoades
first duly sworn, deposes and says that he is the publisher of ENTER-
PRISE, a legal weekly newspaperprinted and published at Blair, in Washing-
ton County, Nebr. and of general circulation in said County and State; that said
newspaper has a bona fide circulation of more than 300 copies weekly, in said
County; and, has been published in said County for more than 52 successive
weeks prior to the first publication of the attached notice, that the attached
notice was published in said newspaper for ..... h.hz.e e.......... consecutive
week being the issues of.
.MarP_h ... 2 .... ........................19..9.5
.March 1 ?.I ....................... 19
95
March 23
........... ............................... . 19 9 5
.................. ............................... 19......
19 ......
.............................
Publisher's Si " " " " " " " " "'
gnature
Subscribed in my presence and sworn to before me
........... PEG March
GENERA, NOTARY• °' t ..................... ............................... 19..9.5
III GY NOTARY-Slate al F:;,
L. t11PNi-
hty Comm. Exp. Nov. 2q r.
N° otary Public
Printers Fees For Publishing This Notice .......
Preparation of Affidavit and Billing ......................... $ — 3 - Z� 3
Notary Fees ....... g ............. ............................... $
Copy............................................................. ............................... $
.................. $
TO BE FILED Real Estate Transfer Statement r J FORM
WITH REt ISTER This Statement is Confidential — for Tax Officials Only
OF DEEDS • Read Instructions on reverse side
THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT
IS SIGNED AND LINtS 7 -"l5 AKr-
AL;UUKA 1 tLT L umrLC 1 emu
1 County Name 2
County Number
3 Date of Sate
4 Date of Deed
Washington
B9
the North line of Lot 1; thence Northwesterly along said exten-
Mo. 4_ Day A r.
Mo. d Day Yr. 9
5 Grantor's Name, Address, and Telephone (Please Print)
6 Grantee's Name, Address, and Telephone (Please Print)
Grantors Name (Seller)
square feet more or less.
Grantee's Name (Buyer)
City of blair
Memorial Community Hospital
Street or Other Mailing Address
24 Adjusted purchase price paid for real estate line 22 minus line 23 24 $
1,075 0
Street or Other Mailing Address
218 South 16th Street
correct, and that 1 am duly authorized to sign this statement.
810 NW4 22nd Street
City
State
Zip Code
City State Zip Code
Blair NE
68008
Date
Blair NE 68008
Telephone Number
( )
26 Date Deed Recorded Z7 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page
30
Telephone Number
)
7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home.
(A) Status
Supersedes 2- 146-67 Rev. 11 -92
NEBRASKA DEPARTMENTOF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE - Goldenrod Copy
(B) Property Type
(C)
(1)® Improved
(1) ❑ Single Family
(4) ❑ Industrial
(6) ❑ Recxeabonal (8) ❑ Mineral Interests - (9) ❑ State Assessed
(1) ❑ Mobile Home
(2)❑ Unimproved
(2) ❑ Mutti-Family
1
(5) ❑ Agricultural
(7) ❑ Mineral Interests - Producing (10) ❑ Exempt
(3)0 IOLL
(3) ❑ Commercial
Nonproducing
8 Type of Deed
❑ Warranty ❑ Sheriff
❑ Executor
❑ Mineral ❑ Cemetery
9 Federal Employer Identification or Social Security Number(s) of
Grardee(s) (d more than two, attach list)
® Quit Claim ❑ Conservator
❑ Partition
❑ Trust ❑ Other
10 Type 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? (d No, state intended use)
® YES ❑ NO X ® YES ❑ NO
❑ YES [ONO ❑ Spouse
Grandparents and Grandchild
❑ Parents and Child ❑ Family Corporation or Partnership
_ Brothers and Suers 0 Aunt or Uncle to Niece or Nephew u Other
14 If the real estate was transferred for nominal consideration, what is the current market 15 Was mortgage assumed? K Yes, state amount and interest rate.
value? ❑ YES X ® NG X $ 1 %
16 Does this conveyance divide a current parcel of land? 17 Was sale through a real estate agent? (rf Yes, name of agent)
❑ YES ®NO ❑YF.S QNO
18 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent
Memorial Community Hospital
810 North 22nd St., Blair, NE 68008
20 legal Description Beginning at the Northeast corner of Lot 1, Block 1, Hospital
'Park
Addition and assuming the East line of said Lot 1 to bear
due North and South; thence South along said East line a distance
of 338.77 feet; thence East a distance of 15.od feet; thence
North a distance of 329.67 feet to the Southeasterly extension of
the North line of Lot 1; thence Northwesterly along said exten-
sion a distance of 17.54 feet to the point of beginning, all in
21 If agricultural, list tota the City of Blair, Washington County, Nebraska, containing 5013.3
square feet more or less.
22 Total purchase price, including any liabilities assumea ....... ......... _ . . _ _ .. .. ___ _
1,075 0 0
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 $
1,075 0
Under penattles of law, I declare that I have examined this statement and that it is, to the best of my knowledge and belief, tree and
correct, and that 1 am duly authorized to sign this statement.
25
Print or Type Naive of Grantee'or Authorized Representative
Telephone Number
sign
I F Signature of GrameeprAuthonzed Representative Title
Date
REGISTER OF DEEDS' USE ONLY
FOR NDR USE ONLY
26 Date Deed Recorded Z7 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page
30
Mo. Da Yr. $
Nebraska Department of Revenue Form No. 2- 146-67 Rev. 9-94 Authorized by Sections 76-214, 77.1327, R.R.S. 1943
Supersedes 2- 146-67 Rev. 11 -92
NEBRASKA DEPARTMENTOF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE - Goldenrod Copy
QUIT CLAIM DEED
THIS INDENTURE made this _V day of _Q , 1995, between
the City of Blair, Nebraska, a Municipa Corporation, herein
called the grantor whether one or more, and Memorial Community
Hospital, herein clled the grantee whether one or more,
WITNESSETH, that the said grantor, in consideration of the sum of
One Dollar and other valuable consideration to it duly paid, the
receipt whereof is hereby acknowledged, remised, released, and
quit - claimed, and by these presents do remise, release, and
forever quit -claim unto the said grantee, and to his, her or
their heirs and assigns forever all his, her or their right,
title, and interest in and to the following described real es-
tate:
Beginning at the Northeast corner of Lot 1, Block 1, Hospital.
Park Addition and assuming the East line of said Lot 1 to bear
due North and South; thence South along said East line a distance
of 338.77 feet; thence East a distance of 15.00 feet; thence
North a distance of 329.67 feet to the Southeasterly extension of
the North line of Lot 1; thence Northwesterly along said exten-
sion a distance of 17.54 feet to the point of beginning, all in
the City of Blair, Washington County, Nebraska, containing 5013.3
square feet more or less.
Together with all and singular the hereditaments thereunto be-
longing. TO HAVE AND TO HOLD the above described premises unto
the said grantee and to grantee's heirs and assigns forever so
that neither the said grantor, nor any person in his, her or
their name and behalf, shall or will hereafter claim or demand
any right or title to the said premises or any part thereof, but
they and every one of them shall be these presents be excluded
and forever barred.
Attest: City of Blair, Nebraska
A Municipal Corporation
Alice I. Diedrichsen, Michael A. Mines, Mayor
City Clerk
STATE OF NEBRASKA, County of Washington:
Before me, a notary public qualified for said county, per-
sonally came Michael A. Mines, Mayor of the City of Blair, Ne-
braska, a Municipal Corporation, known to me to be the identical
person who signed the foregoing instrument and acknowledged the
execution thereof to be his voluntary act and deed.
GENER=Nw. y hand and Notarial seal on LGSiF,C� , 1995.
A
/J pp G1
My Commission expires.
//-/4 Notary Public
STATE OF NEBRASKA, Washington County :ss
Entered on numerical index and filed for record in the Register
of Deeds Office of said County the day of ,
1994, at o'clock _.M., and recorded in Book
of at page
By
Reg. of Deeds
Deputy
NOTICE
The Mayor and City
their regular meeting
an Ordinance providing
real estate:
Council of the City of
in February 28, 1995,
for the sale of the
Blair, Nebraska, at
passed and approved
following described
Beginning at the Northeast corner of Lot 1, Block 1,
Hospital Park Addition and assuming the East line of
said Lot 1 to bear due North and South; thence South
along said East line a distance of 338.77 feet; thence
East a distance of 15.00 feet; thence North a distance
of 329.67 feet to the Southeasterly extension of the
North line of Lot 1; thence Northwesterly along said
extension a distance of 17.54 feet to the point of
beginning, all in the City of Blair, Washington County,
Nebraska, containing 5013.3 square feet more or less.
The real estate is being sold to Memorial Community Hospital
pursuant to the terms and conditions of an agreement between
Memorial Community Hospital and the City of Blair. The purchase
price for the real estate is the sum of $1,075.00. The specific
terms and conditions of the agreement are available for public
inspection at the office of the City Clerk of the City of Blair,
Nebraska, during regular business hours.
ALICE I. DIEDRICHSEN, CITY CLERK
Please publish M arch 2, 16, 1995, and furnish one proof of
publication.
y r
�4j3
AGREEMENT FOR THE SALE OF REAL ESTATE
This agreement made this i6 day of , " a)z -c - 1, ' , 1995,
by and between the City of Blair, Nebraska, a Municipal Corpora-
tion, hereinafter referred to as "Seller," and Memorial Community
Hospital, hereinafter referred to as "Buyer."
WITNESSETH:
Seller agrees to sell and convey to the Buyer by Quit Claim
Deed, free and clear of all encumbrances except easements and
restrictions of record, the following described real estate, to
wit:
Beginning at the Northeast corner of Lot 1, Block 1,
Hospital Park Addition and assuming the East line of
said Lot 1 to bear due North and South; thence South
along said East line a distance of 338.77 feet; thence
East a distance of 15.00 feet; thence North a distance
of 329.67 feet to the Southeasterly extension of the
North line of Lot 1; thence Northwesterly along said
extension a distance of 17.54 feet to the point of
beginning, all in the City of Blair, Washington County,
Nebraska, containing 5013.3 square feet more or
less,
and said ,Buyer agrees to purchase said property on the following
terms and conditions, to -wit:
The purchase price therefore is agreed to be the sum of
$1,075.00 which said sum shall be payable in cash upon execution
of this agreement. Closing of the transaction shall be on or
before forty -five (45) days following passage of an ordinance by
the City of Blair approving the sale herein.
It is understood and agreed by and between the parties
hereto that Buyer shall receive possession of the premises upon
closing.
The Buyer shall be responsible for and shall pay any real
estate taxes which may be or become due on said real estate.
The Seller specifically makes no warranties or representa-
tions as to the condition of the premises nor their usability as
may be intended by the Buyer. The Buyer has made an inspection
of the property and is familiar with the condition thereof and is
not relying upon any representations made with reference thereto
by the Seller except those set forth herein.
The Seller shall not have any obligation or liability to
provide a survey of the premises.
STATE OF NEBRASKA �
WASHINGTON COUNTY )
/ _ .�.� 1995, before me, the
On this �Lo
�, day of S V1
undersigned a Notary Public, duly commissioned and qualified for
in said county, personally came Michael A. Mines, Mayer of the
City of Blair, Nebraska, Seller, to me known to be the identical
person whose name is affixed to the foregoing agreement and
acknowledged the execution thereof to be his voluntary acct and
deed.
MY COMMISSION EXPIRES:
) .ss:
WASHINGTON COUNTY )
On this /6 day of `����` � ��' _ , 1995, before me, the
undersigned a Notary Public, dulj commis ioned and qualified for
in said county, personally cam a nc_ duly author -
ized officer of Memorial Community Hospital, Buyer, to me known
to be the identical person whose name is affixed to the forego-
ing agreement and acknowledged the execution thereof to be
his /her voluntary act and deed.
WITNESS my hand and Notarial Seal the day and year last
above written.
eL LL'_z
NOTARY PUBLIC
MY COMMISSION EXPIRES:
In the event the Buyer requests, Seller shall provide to the
Buyer a title insurance commitment to said premises showing good
and marketable fee simple title in it for conveyance to said
Buyer. The cost of such title insurance shall be paid solely by
the Buyer.
This agreement shall be subject to the filing of any remon-
strance pursuant to Nebraska Statutes against the exchange of
this property by Blair wherein such remonstrance would be deemed
to be valid and which would prohibit, pursuant to the statutes of
the State of Nebraska, the conveyance of the property by the City
of Blair. In the event of such remonstrance, the purchase price
shall be returned to the Buyer. Under no other circumstance
shall the Buyer be entitled to a refund of the purchase price.
This agreement executed the date first aforesaid shall be
binding upon the assigns and successors of all parties hereto.
CITY OF BLAIR, NEBRASKA
BY ,.
MICHAEL A. MINES, MAYOR
ATTEST:
ALICE I. DIEDRICHSEN, CITY CLERK
Me
By