1993-05-28 Greater Blair Corporation-100
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TO BE FILED R ea l E s t a t e T rans f er St a t emen t FORM
WITH REGISTER This Statement is Confidential — for Tax Officials Only
OF DEEDS a Read instructions on reverse side
® THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 THROUGH 19 ARE PROPERLY COMPLETED
COUNTY ASSESSOR'S USE ONLY
County Name County No. Sales No. Location I.D.
8 Ownership Transferred in Full (if no, explain) 9 Was sale between relatives? (if yes, state relationship)
a',Q YES ❑ NO I ❑ YES NO
10 If the real estate was transferred for nominal 11 Was mortgage assumed? (if yes, state amount and interest rate)
consideration, what is the current market value? $ ❑ YES NO $ %
12 Does this conveyance divide a current 13 Was sale through a real estate agent? 14 Was real estate purchased for same use? (if no, explain)
parcel of land? ❑ YES -E] I ❑ YES [Z NO ye-3
15 Address of Property City State, Zip Code
'7T 1��. tiOrf
16 Legal Description
Lea,, . L: 161 11i St`'.CL:Lmi ✓ l vx&hip J-3 s 3 a
, e 12 j4a,�"aL of 1 �r�t1 l .l' , r .'� akg t7si
C( )i,XiL;y, Jel:rra:,a:ka
I
17 Total purchase price including any liabilities assumed ...................... .......... `........... 17 $ 00
18 Was non real property included in purchase? ❑ Yes IN No (If yes, enter amount and attach itemized list) ........ , . 18 $ w +U— 1 00
I
19 Adjusted purchase price paid for real estate (line 17 minus line 18) ......... ............................... 19 $ 1 00
Under penalties of perjury, 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 I am duly authorized to sign this statement.
Signature Title Date
REGISTER OF DEEDS' USE ONLY
20 Date Deed Recorded
Month AL Day Year
21 Value of Stamp or Exempt 2 Number
$ 8 >'t 1 C_C
22 Deed Book
23 Deed Page
�
COUNTY ASSESSOR'S USE ONLY
Property Type
(1) ❑ Single Family (4) ❑ Commercial (7) ❑ Agricultural (Total
No. of Acres )
(2) ❑ Multi Family (5) ❑ Industrial (8) ❑ Mineral Interests
(3) ❑ Home Sites (6) ❑ Recreational (9) ❑ Other
Cabins etc.
1 Date of Sale
Month Day Year l°`
2 Date of Deed
Month Da Yea 13
Y
3 Grantor's Name, Address, and Telephone
4 Grantee's Name, Address, and Telephone
Grtor's N , ASgJla
8s 3 Sat I w ; on
�
Grardee's.,Name. (Buyer)
ti�e—I eta "ki L iL Co.
Street or Other Mailing Address
Str It gr�Other, jIing Address
V . 3)C3a, , t00
City,, „. _ State Zip Code
City State Zip Code
Telephone Number
Telephone Number
5 Federal Employer Identification or Social Security Number r r
Y �
of Grantee(s) (if more than two, attach list) k
6 .Type of Deed
i7 )fl U )x 7
7 Type of Transfer
1:1 sale El Gift El Exchange El Foreclosure El Satisfaction of Contract !:Other (explain) "=
8 Ownership Transferred in Full (if no, explain) 9 Was sale between relatives? (if yes, state relationship)
a',Q YES ❑ NO I ❑ YES NO
10 If the real estate was transferred for nominal 11 Was mortgage assumed? (if yes, state amount and interest rate)
consideration, what is the current market value? $ ❑ YES NO $ %
12 Does this conveyance divide a current 13 Was sale through a real estate agent? 14 Was real estate purchased for same use? (if no, explain)
parcel of land? ❑ YES -E] I ❑ YES [Z NO ye-3
15 Address of Property City State, Zip Code
'7T 1��. tiOrf
16 Legal Description
Lea,, . L: 161 11i St`'.CL:Lmi ✓ l vx&hip J-3 s 3 a
, e 12 j4a,�"aL of 1 �r�t1 l .l' , r .'� akg t7si
C( )i,XiL;y, Jel:rra:,a:ka
I
17 Total purchase price including any liabilities assumed ...................... .......... `........... 17 $ 00
18 Was non real property included in purchase? ❑ Yes IN No (If yes, enter amount and attach itemized list) ........ , . 18 $ w +U— 1 00
I
19 Adjusted purchase price paid for real estate (line 17 minus line 18) ......... ............................... 19 $ 1 00
Under penalties of perjury, 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 I am duly authorized to sign this statement.
Signature Title Date
REGISTER OF DEEDS' USE ONLY
20 Date Deed Recorded
Month AL Day Year
21 Value of Stamp or Exempt 2 Number
$ 8 >'t 1 C_C
22 Deed Book
23 Deed Page
�
COUNTY ASSESSOR'S USE ONLY
24 Parcel Identification
28 Agricultural Land
Township
Section
Quar.
Subdivision
Block
Parcel Number
LVG
No. of Acres
LVG
No. of Acres
25 Improved Parcels
Arch Type
Occ. Code
CC
Quality
No. of Stories
Story Height
Floor Area
Basement
Finish
Garage Stall
Garage Type
Year Built
Modernization /Rehab
Miscellaneous
RCN
$ 00
Miscellaneous
Depreciation Study Reason No.
1-1 YES El NO
Does land adjoin current operating
unit?
❑ YES ❑ NO
Irr. Type
Total Acres /Lots
26 Platted Lots
Zoning
Irreg.
Front
Depth
29 Land Value .
29
$ i 00
Lot Size
Street Improvement
Site Improvement
30 Improvement value
30
$ 00
27Should this sale be used in an assessment /sales If no, give nonuseable sales code
ra tio study? ❑ YES ❑ NO
31 Total value (line 29 plus
line 30)
31
$ 00
Nebraska Uepartment of Hevenue f-orm Iva. 2 - 14b -er- hev. iu -u5 �r
Q.--d— 9_148 - R7 Rev_ 11 -79