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KEEP ME
This is
Your legal description for your Real Estate,
and you will always have it
for future use
City of Blair
W. 34 ft of Lot 14, Weimer' Add.
Blair
C HARLOTTE L. PETERSEN
County Clerk & Register of Deeds
81air, Nebraska 68008
e
TO BE FILED
21 Value of Stamp or Exempt Number
J
$ .,' �' ,' .1 '
Real Estate T State
FORM
WITH REGISTEF:
24 Parcel Identification
This Statement is Conf — for Tax Off icia ls Only
Township
OF DEEDS
I Quar.
0 Read instructions on reverse side
Block
THE DEED WILL
NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 THROUGH 19 ARE PROPERLY COMPLETED e
No, of Acres
COUNTY ASSESSOR'S USE ONLY
No. of Acres
County Name
I County No.
I Sales No.
Location I.D.
Arch Type
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 Dced
(3) ❑ Home Sites (6) ❑Recreational (9) ❑Other Month Day YeaJ- Month DayYear
(Cabins, etc.)
3 Grantor's Name, Address, and Telephone 4 Grantee's Na Add an d T e lep h o ne
Grantor's Name (Seller) Grantee's Name (Buyer)
Dell Porter t a Municipal
Street or Other Mailing Address m Street o" Other Mailing Addr ss Corporation
1171 South l3th Street 218 South Irtb Street
City State Zip Code City State Zip Code
B lair, Nebraska 68008 n e b ra s ka 6
Telephone Number Telephone Number
5 Federal Employer Identification or Social Security Number 6 Type of Deed
of Grantee(s) (if more than two, attach list)
7 Type of Transfer
❑ Sale ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Other (explain)
8 Ownership Transferred in Full (if no, explain) 9 Was sale between relatives? (if yes, state relationship)
❑ YES NO ❑ 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 pur ' c ased for same use? (if no, explain)
parcel of land? ❑ YES ❑ NO ❑ YES NO k YES ❑ NO
15 Address of Property City State Zip Code
16 Legal Description The West 34 Lot 14 in WeimerOs Addition to the City
Blair, Washington County, Nebraska.
17 Total purchase price including any liab assumed ........ ............................... .
18 Was non real property included in purchase? ❑ Yes ❑ No (If yes, enter amount and attach itemized list) ...... .
,
19
19 Adjusted purchase price paid for real estate (line 17 minus line 18).. ... ......... 19 $
1 00
00_ I
,..,Under penalties of perjury, I declare that 1 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 —y Date
here
REGISTER OF DEEDS' USE ONLY
20 Date DepO Recorded ,.
/� r
Mont Davy / Year._ 6:,
21 Value of Stamp or Exempt Number
J
$ .,' �' ,' .1 '
22 Deed Book
23 Deed Page
/ ;.
COUNTY ASSESSOR'S USE ONLY _
24 Parcel Identification
28 Agricultural Land
Township
Section
I Quar.
I 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 I
$ UU
Miscellaneous
Depreclatlon Study Reason No.
❑ YES ❑ NO
Does land adjoin current operating Irr.
unit?
❑ YES ❑ NO
Type
Total Acres /Lots
26 Platted Lots
Zoning
Irreg.
Front
Depth
29 Land value
29
I
$ i�00
Lot Size
Street Fmprovement
Site Improvement
30 Improv value ...
30
$ 100
27 Should this sale be used in an assessment /sales If no, give nonuseable sales code
ratio study? ❑ YES ❑ NO
31 Total value (line 29 plus
line 30 . .
31
I
$ 100
Nebraska Department of Revenue Form No. 2- 14b -b/ Rev. 10 -8t) Hurnonzeu oy a--Fl - -tai+, r - 1341, -,.oco
Supersedes 2- 146 -67 Rev. 11 -79
COUNTY ASSESSOR — White and Canary Copies NEBRASKA DEPARTMENT OF REVENUE — Pink Copy GRANTEE — Goldenrod Copy