1997-06-26 Dana CollegeCity State Zip Code city State Zip Code
Telephone Number Telephone Number
7 PROPERTY CLASSIFICATI NUMBER. Check one box in catec3ories A and B. Check C also if property is mobile home.
10 Type of Transfer
❑ Sale ❑ Auction
❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain)
71 Ownership Transferred in Full (if No, explain division) 12 Was real estate purchased for same use? (if No, state intended use)
YES ❑ NO YES ❑ NO
® 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 0 NO $ %
16 Does this conveyance divide a current parcel of land? I 17 Was sale through a real estate agent? (if Yes, name of agent)
❑ YES ONO [:I YES NO
18 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent
20 Legal Description
u
j_
21 If agricultural, list total number of acres
22 Total purchase price, including any liabilities assumed ...................................................
9
23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) ... 23
24 Adjusted urchase rice paid for real estate line 22 minus line 23 . . ........ ............................... 24
Under penakles 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.
:! z
Print or Type7dame of �ranfee or Authorizedlepresentative " Telephone Number
sign
h e re nature of Grantee or Authorized Representative Idle Date
REGISTER OF DEEDS' USE ONLY
FOR N ®R USE ONL Tj
26 Date Deed Recorded
Mo. Day
(B) Property Type
(1)r� Improved
il (1) Single Family
(4) Industrial
(6) 0 Recreational (8) 0 Mineral Interests- (9) E] State Assessed �(1) Mobile Home
(2)E] Unimproved
(2) 0 Mufti-Family
(5) Agricultural
(7)EI Mineral Interests- Producing (1 o) EIE-
•
Commercial
• • •• h •
8 Type of Deed
0 Warranty
ED Sheriff
11 Executor
r 1
0 Mineral 11 Cem
El Quitclai
10 Type of Transfer
❑ Sale ❑ Auction
❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain)
71 Ownership Transferred in Full (if No, explain division) 12 Was real estate purchased for same use? (if No, state intended use)
YES ❑ NO YES ❑ NO
® 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 0 NO $ %
16 Does this conveyance divide a current parcel of land? I 17 Was sale through a real estate agent? (if Yes, name of agent)
❑ YES ONO [:I YES NO
18 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent
20 Legal Description
u
j_
21 If agricultural, list total number of acres
22 Total purchase price, including any liabilities assumed ...................................................
9
23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) ... 23
24 Adjusted urchase rice paid for real estate line 22 minus line 23 . . ........ ............................... 24
Under penakles 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.
:! z
Print or Type7dame of �ranfee or Authorizedlepresentative " Telephone Number
sign
h e re nature of Grantee or Authorized Representative Idle Date
REGISTER OF DEEDS' USE ONLY
FOR N ®R USE ONL Tj
26 Date Deed Recorded
Mo. Day
27 Value of Stamp or Exempt Number
28 Deed Book
29 Deed Page
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
COUNTY ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy
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