1997-02-06 P&WI U Was sale between relatives? (If Yes, check appropriate box)
® YES ❑ NO ® Spouse ® 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 15 Was mortgage assumed? If Yes, state amount and interest rate.
value? ❑ YES ❑ NO $ %
16 Does this conveyance divide a current parcel of land? 17 Was sale through a real estate agent? (if Yes, name of agent)
❑ YES []NO ❑YES ❑,NO
16 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent
20 Legal Description
21 If agricultural, list total number of acres
22 Total purchase price, including any liabilities assumed ...................................................
23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) ...
$
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 1 am duly authorized to sign this statement.
Print or Type Name of Grantee or Authorized Representative Telephone Number
sign
h e re Signature of Grantee or Authorised Representative Title Date
REGISTER OF DEEDS' USE ONLY
FOR NDR USE ONL
(B) Property Type
27 Value of Stamp or Exempt Number
(1)f Improved (1) E] Single Family
(4) [D lndus��
Recreational (8) Mineral Interests- (9) [-] State Assessed
(2)[3 Unimproved (2) [] Mufti-Family
(5) Agricultural
Producing
(7) Ej Mineral Interests-
(10) [3 Exempt
■ • 3 ®
(3) Commercial
• • • • •in
8 Type of Deed
Yr ✓ x l'l J
E]War ranty [:1 Sheriff
0 Executor
F� Mineral Cemetery
'��.
�� �'
Quit Cl � • - •
� Part ition
v Other
� E]
's J -`�✓�' .,r I t j s-u' �".�,,., ;,'
10 Type of Transfer
El Sale [:1 Auction [__1 Gift
E]Exchange
Foreclosure Satisfaction of Contract
Life Estate Other (explain)
I I Ownership Transferred in Full (if No, explain division)
Was real estate purchased for same use? (if No, state intended use)
® YES NO
YES
NO
I U Was sale between relatives? (If Yes, check appropriate box)
® YES ❑ NO ® Spouse ® 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 15 Was mortgage assumed? If Yes, state amount and interest rate.
value? ❑ YES ❑ NO $ %
16 Does this conveyance divide a current parcel of land? 17 Was sale through a real estate agent? (if Yes, name of agent)
❑ YES []NO ❑YES ❑,NO
16 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent
20 Legal Description
21 If agricultural, list total number of acres
22 Total purchase price, including any liabilities assumed ...................................................
23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) ...
$
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 1 am duly authorized to sign this statement.
Print or Type Name of Grantee or Authorized Representative Telephone Number
sign
h e re Signature of Grantee or Authorised Representative Title Date
REGISTER OF DEEDS' USE ONLY
FOR NDR USE ONL
26 Date Deed Recorded
Mo. Day Yr.
27 Value of Stamp or Exempt Number
26 Deed Book
Deed Page
30
Nebraska Department of Revenue Form No. 2.146 -67 Rev. 9 -94
Supersedes 2- 146.67 Rev. 11.92
NFRRASICA nFPARTMFNT OF RFVFNI IF — White Cnnv COUNTY ASSESSOR — Canary and Pink Cnnies
Authorized by Sections 76. 214, 77 -1327, R.R.S. 1943
GRANTEE — Goldenrod Coov
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