1988-06-15 Aten propertyTO BE FILED
Real Estate T Stateme
FORM
WITH REGISTER
OF DEEDS
This Statement is Confidential — for T ax Officials Only
1 2 4 Parcel Identification
26 Agricultural Land
® Read instruc on reverse side
Section
®THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 THROUGH 19 ARE PROPERLY COMPLETED 0
COUNTY ASSESSOR'S USE ONLY
Block
County Name
County No.
I Sales No.
Location I.D.
Property Type
(1) ❑ Single Family (4) Commercial (7) Agricultural (Total
No. of Acres )
(2) ❑ Multi Family (5) Industrial (8) Mineral Interests
1 Date of Sale
2 Date of Deed
(3) ] Home Sites (6) Recreational (9) C]Other�
(Cabins, etc.)
Month Day Yeai
Month Day Year
3 Grantor's Name, Address, and Telephone
4 Grantee's Na Address, and Telephone
Grantor's Name (Seller)
Grantee's Name (Buyer)
r, n . ... t*aa Ater r. u � rx d '€. F Y`j
't
�.�.1h I Cit- � B lair it T' s" t'� a
Street or Other Mailing Address
Street or Other Mailing Address
Y.,
C. 9 0 `' �{,�}S. Lb 1 1 :3"$. s - c-,_t
21.8 Fbu r i 31 6 li
City State Zip Code
City State Zip Code
s .�_.. r i�' c 1p a
1 3 3.1
_ g +jf t t i _. 3 f ) 01
r
Telephone Number
Telephone Number
5 Federal Employer Identification or Social Security Number 16 Type of Deed
of Grantee(s) (if more than two, attach list) - f ^s
01.17 _z��T=.
7 Type of Transf r � r � ]. �
E] Sale [J U Gift Exchange i Foreclosure [] Satisfaction of Contract r] Other (explain)
8 Ownership Transferred in Full (if no, explain) 9 Was sale between relatives? (if yes, state relationship)
YES ❑ NO �� YES -1 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 sarne use? (if no, explain)
Parcel of land? [:] YES YES NO YES ❑ NO
15 Address of Property City State Zip Code
111 Ax . , TIPY.
16 Legal Description O
C „� E- 140 8 >° f � .e.. ""1
East .: 24�?�'� `t,� Cad S�':'{. 1 12t�� the ��.���° '�.� �P�''# � of `�.�1�. ��i�a1� <., 'rc =�$:, x. �a� , -e
in I_ock 11. Dmcter Ricon'd A&Iition to. tjx e City o.- tSlnir, ' ebnsska, I n
17 Total purchase price including any liabilities assumed .... ................ O -F!0M 00
18 Was non real property included in p urchase? ❑ Yes ❑ No (If yes, enter amount and attach itemized list) ....... 18 $ 1 0 0
19 2dit_i purchase price paid for real estate (line 17 minus line 18) •,1 ;p' p£°� 00
Linder 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.
sign k
h ere " Signature Title Date
REG ISTER OF DFF USF ONLY
20 Date Deed Recorded
Month Day/. Yea r—
21 Value of,Stampor Exempt Number 'i1
.p
22 Deed Book
23 Deed Page
/ COUNTY A USE ONLY
1 2 4 Parcel Identification
26 Agricultural Land
Township
Section
Quar.
Subdivision
Block
Parcel Number
LVG
No. of Acres
LVG
No. of Acres
F 2 5 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
JRCN
Miscellaneous
Depreclatlon Study Reason No.
I L1 Y ES ❑ N O
Does land adjoin current operating Irr.
unit.
❑ YES ❑ NO
Type
Total Acres /Lets
26 Platted Lots
Zonii,g Ineg. Front Depth
Lot Size Street Improvement Site Improvement
27 Should this Sala be used in an assessment/sales If no, give nonuseable sales code
rat r €u ty? 1 -
�r F5 J NO
29 Land value .
30 imp rovement value . .
20
30
31
$ I fly;
$ 1 00
I �
Cr
31 Total value (line 29 r
-
line 0). ..
Nebi<si<a Department of Revenue r-c.rm No. 2- 14'6 -67 Rev. 10 -8S Ft.,tnon. =ed uy re -214, ls,'d
Supersedes 2- 146 -67 Rev. I1 -79
CORN! i Y ASSESSOR /Mire an(A `..anary Copias NEBRASKA. DEPARTMENT OF R"I'VENC;E -- ('.n < Copy 'GRAN FEE Gold -mrod Copy
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KEEP ME
This is your legal descei0tion `for your Real Estate,
and you will always have it for future use
City of Blair
}
E 240.8' Lot 1, W 40.8' of E 140.8'
I
Lot 2, Blk. 19, Dexter's 2nd Add,
Blair
CHARLOTTE L. PETERSEN
County Clerk & Register of Deeds
Blair, Nebraska 68008
11