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cemetary quitclaim deedsBrenda Wheeler From: atripp @tripplawoffice.com Sent: Friday, July 15, 2011 6:27 AM To: Brenda Wheeler Subject: Cemetary Lots (Wulf) Brenda, I spoke with the family and reviewed the Court documents in the Estate of Fred Wulf. The family appears to be correct that the plots were included in the probate but never deeded out of it. All of the living heirs and the children of the deceased heirs have signed the document indicating the fact that have no objection to the transfer. I reviewed the probate documents to verify that all heirs were accounted for. Common sense would dictate that the transfer is fine as all heirs consent. I would encourage the cemetary to at least have the signed document to transfer on file to avoid any possible confusion down the road. Adam R. Tripp (NE 23856)(ND 06221) 141 E. Military Ave P.O. Box 375 Fremont, NE 68026 -0375 (402)721 -7790 PRIVILEGED ATTORNEY- CLIENT COMMUNICATION This e -mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act, 18 U.S.C. Sections 2510 -2521. This e -mail is confidential and may contain information that is privileged, attorney work product or exempt from disclosure under applicable law. Recipients should not file copies of this e -mail with publicly accessible records. If you have received this message in error, please immediately notify the sender by return e-mail and delete this e-mail message from your computer. Thank you. TO WHOM IT MAY CONCERN a s xy 11 �, The undersigned, representing all of the heirs of the Atate of Fred Wulf, probated in the courts of Washington County, Nebraska, case #5339, Book K, Page 372, hereby consent to the transfer of all the heirs' rights to burial plots #'s 10,11 and 12 of Lot 3, Block 80 in the City of Blair Cemetery, Washington County, Nebraska to Luanne C. (Wulf) Sorensen, and/or Richard L. Sorensen, husband and wife, and to their children, Corey Sorensen and Kaylene (Sorensen) Nelson. The undersigned further give their consent for the Sorensen surname to be inscripted onto the west side of the monument located on lot #'s 1, 2 and 3 of Lot 3, Block 80 as shown on the attached Exhibit. Earl Wulf Date: :Z:] " C �/G ?itit rc�r� 31 Anna Ibsen Date: Children of Eggert Wulf in Wulf Date: f a� Vernon Wulf Date: Children of Freddie Wulf: Fredrick Wulf Date: r I r 3loann Nicklaus Date: Luanne Soren en Lye ulf bate: z 0 0 Lrl m -11 Ql: \411 i W b �� I LI—I IN IM 'jo re ..12 w i b �� I LI—I IN m L FA Al }i � f i�; IN m L FA Al }i � f i�; HALL LAw OFFICES, L.L.O. Counizfo and ogtto wF-y at -'acv GEOFFREY C. HALL 1664 Washington St. • P.O. Box 216 Blair, Nebraska 68008 Telephone: (402) 426.4424 Facsimile: (402) 426.4666 January 28, 2009 Linda Traxler 24024 NE 64" Ct: Redmond, WA 98053 RE: Affidavit of Dorothy L. Dinkins Dear Mrs. Traxler: 238 S. 13th Street Tekamah, Nebraska 68061 Telephone: (402) 374.2100 Facsimile: (402) 426 -4666 Pursuant to your request, please find enclosed the Affidavit of Dorothy L. Dinkins recorded at the Washington County Register of Deeds office. I have forwarded a copy of the Affidavit to the City Offices for their records. The City records will show that Dorothy is now the owner of the 8 remaining cemetery plots. Please keep in mind that you will still need Quitclaim deeds for each of the remaining plots in order to sell them. I recommend that you retain another attorney to accomplish the Quitclaim Deeds and transfer statements. Sincerely, HALL LAW OFFICES, P.C., L.L.O. Carol Frahm Assistant to Geoffrey C. Hall /caf Enclosure c: Brenda Wheeler for City of Blair 2 ao6 WASHINGTON COUNTY, STATE OF NEBRASY-A, RECORDED i � 'L;�60 AT 10 � 3 i AK STATE OF OREGON ) npp� 5 3 4 PAGE (S) g - �A R _ 3 ss C.. 2009 JAN 27 Ar' 1 '3 I COUNTY OF COOS ) REGISTER OF DEEDS K DS E iN'' WA SIH 1' TON COUNTY REGIS � O DEED" COMES NOW Dorothy L. Dinkins, and being first duly sworn upon oath , of s that I am over the age of majority, that I am under no legal disability, and I have personal knowledge of the following facts: 1) That Edna Mae Brown is my natural mother and is the listed owner of the cemetery spaces at Blair Cemetery, Block 98, Lot 12, spaces 1 -12 and that the following spaces remain unused: spaces 1, 2 and 4 -9 (see attached Exhibit A); 2) That Edna Mae Brown did not file the Deeds for the cemetery spaces with the Washington County Register of Deeds; 3) That Edna Mae Brown died on February 11, 1946 in Blair, Washington County, Nebraska (see attached Exhibit B); 4) That Pat Long, Cemetery Superintendent, confirmed that because perpetual care had been paid on the cemetery spaces said spaces had not been escheated back to the City of Blair; 5) That I, Dorothy L. Dinkins, am the only surviving child of Edna Mae Brown; 6) That I am requesting that the ownership of said cemetery spaces be transferred into my name so that I can use or sell the remaining cemetery spaces. FURTHER AFFIANT SAITH NOT. of Dorothy L. Di kins SUBSCRIBED AND SWORN to before me, a Notary Public, on this day of ! 1/'e 1k, , 2008 by Dorothy L. Dinkins. Recorded snersl OFFICIAL SEAL Numarlc l WALTER EYLER htlt��tt NOTARY PUBLIC - OREGON Notar Public pnt�d COMMISSION NO. 405800 ry MY COMMISSION EXPIRES MAY 8, -- scanned stars trailer M 425 898 7271 p.4 Mr -.Dorothy L. -.Dinkins `I+@_ . }"343 s Or 97420 -0213 Dear Ms. Dinkins, I am to your letter of : January .25, 1996 regarding future use of a grave space on Block 98 Lot 12 awned by Edna Mae ..Brown. I have enclosed .Pk copy of the lot, which:.ehe owns, showing the.. individual burials along with the information card on each individual. According to our - records, the owner, .Edna Srown .was buri on- Pebruary 17. 1446. The remaining spaces - should be transferred to her heirs or in your case the space in which you intend to be placed should be transferred to you. Once you have all. the transfers in place we would appreciate a copy for -our.files. I.f yo. have anY cue - feel free to contact . at 402 426- :AaC Garcia i�ckerson 402 426 =4191. r3bu c�.i 99 Patrick - ,';4? �i�ricY• ".:v�arir3at�a zaI pet ®Ffl \'" scan traxler Block ............9$....... Lot -- ----- 12 --- ------ i Sps• 1 -12 lot 12 Blk. 98 SP Sold to Brown Edna Mae t 2 a 2 425 898 7271 P.5 Name I Age I Date . lat BIk. Sold to 3 Ralph W Brown r 2/17/1946 , 4 Rate Sps. _.lot �Ik. ' SoEd to g Dam _ 7 Sps. lot :Slk. 8 Sold to . Dote gps- lot Slk. 40 - - Edna a 2/17/1946 � Sold to f 1 larry H Brown 1 / fie _ / 1 ; E Rate 12 T NAME Brown Edna Mae 98 LOT 12 GRAVE 10&11 to i 0 x pp H H F�-I � H y L+ . " DATE OF INTERMENT " 2 / 17 / 19 4 6 AGE �Z O tij ti ti co DATE OF.BIRTH 21,5/1889 DATE OF DEATH 2/11/19 'o PLACE OF 0 - N .'� © DEATH -Blair Washington Nebraska �y Y O .FATHER'S NAME t-J d ton H :104 _H �� MOTHER'S MAIDEN NAME W z x LOT t OWNER Mrs H H'Brown FIINERAL OME Bendorf Funeral Home bok AT]L.'1' MATION 0 A+ 1.- N *�3 C W to fD p o Ns u,E Brown Ralph W {°'• 171, BL 98 LOT 12 GRA`,tE 3 o BATE OF INTERMENT 2/17/19 AGE 22 ,cC t� ICs' t7 f D ATE C,F` BIRTH ILL 281923 3P.`t1; U�' I)EnTg V - 1 1. /19 4 PLACE OF DEA ir Washin i I CU 1 I •ti-+ N ET; j» -C u� v:rri FTinT'•RIlT, unnar �,�..a.+. -t n. __ '1 star traxler - a 425 898 7271 p.2 WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENTQF' AND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE OAFGlW'lRECOkD-DN FILE WITH THE NEBRASKA DEPARTMENT Of HEALTH AND HUMAN SERVICES, WTALAECOIBDs - OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR WTAL RECORDS. DATE OF ISSUANCE STANLEY O PER JUL 2 3 2 M8 A SSZS7 SrATF REGISTRA R DEPARTMENT OF HEALTH AND LINCOLN NEBRASKA HUMAN SERVICES jai 1;.& V: Zjm - L r (H mot 91W keatim) (0) rt fordam b==. haw WM In V. & A. T- Malm 21. 1 ba*bw ea0ft that I w0m" Ow 6mund boo dtat t Lard OM h-----arne is tc p C�p�; ta�,is .M W. . T - -kk-e W cif, a) Ac, tml= or b.Toiw 0-j" Al -Z —fR7 7— _ -1 r m4a� i Xe—, ; , , �r - eF c htrw h . . .......... , L� 3 From: "Hall Law Office (Carol Frahm)" <cafhalllaw @huntel.net> To: <Idtraxler @comcast.net> Sent: Monday, November 03, 2008 11:22 AM Attach: Affidavit of Dorothy Dinkins.doc Subject: Affidavit 9-. • Sincerely, Carol Assistant to Geoffrey Page 1 of 1 11/3/2008 Nov. 10, 2008 City of Blair Attn: Pat Long, Blair Cemetery 218 South 16' Street Blair, NE 68008 Dear Pat, In regard to the cemetery plots owned by Edna Mae Brown, I have enclosed the following information: - -- Letters from Blair City Attorney Geoffrey C. Hall's assistant, Carol Frahm - -- Notarized Affadavit signed by my mother, Dorothy Dinkins (Edna Mae Brown's daughter) - -- Exhibit A - Your letter to Dorothy dated 2/15/96 and the information sheet about the Brawn family's gravesites. (Please note that there was some confusion about the date of birth for Harry H. Brown on this sheet. He was 59 at the time of his death. The error is on the notecard for him which listed his birthdate incorrectly as 1887. It should have read 1882, like the tombstone.) - -- Exhibit B - Edna Mae Brown's death certificate. Carol Frahm said that I should mail these directly to you, so that you can change the ownership of these plots into Dorothy's name. She was going to check with Mr. Hall about the next step. Carol also said that when they are in Dorothy's name, I can act as her Power of Attorney in deciding what to do with them. But, after her death, the POA ends. Then, they would become part of her estate. Since Dorothy is 91, I would like any sales to benefit her healthcare. My mom (Dorothy) and I just want to be assured that she has a place for her ashes to be bw•ied near her parents. You were going to check on whether her tombstone would fit appropriately in the area of spaces 10 -12 . If not, another idea might be to use space #1 across from her mother? It would appear then, that we would sell spaces 4, 5, 6, and 7, 8, and 9 (unless 99 is needed to move the tombstones by her parents ?). There are no remaining family members who would be using these graves. I have very much appreciated your help with this matter so far. Thanks for helping us through the rest of this process, as soon as possible. Sincerely, Linda Traxler (Dorothy Dinkins daughter and Edna Mae Brown's granddaughter) 24024 NE 64t Ct., Redmond, WA 98053 Phone 425 -836 -8988 Ceo Friday, October 31, 2008 11:03 AM ^x all U �cno,omaniaxo^u-|ne�� ` sr�ax�,a000c^m "muav|to,Dorothy ommns,uoc <24xs)' Exhibit Avdr(uuzxe) Exhibit B,pd,(@zuo) Dear Linda, Please find attached an Affidavit and two Exhibits concerning the Blair Cemetery �����nt� Af�davdand A�ouhernenta. Dorothy U yv�needtoaignthe/�f�avitin ' - � - N ' �obary Please mail the executad Affidavit and Exhibits directly to Pat Long at the following add| City ofBlair Attn: Pat Long, Blair Cemetenj 218 South 16th Street Blair, NE 68008 If you have any questions, please do not hesitate to contact me at (402) 426-4424. Sincerely, Carol Frahm Assistant to Geoffrey C. Hall 6 "ttn�Yuozoc4��.nz�� _ `_--_-.^~^n~"h"""^°suo6n/uu-Ii/mwx8L — 10/31/2008 STATE OF OREGON ) ss COUNTY OF COOS COMES NOW Dorothy L. Dinkins, and being first duly sworn upon oath, states that I am over the age of majority, that I am under no legal disability, and I have personal knowledge of the following facts: That Edna Mae Brown is my natural mother and is the listed owner of the cemetery spaces at Blair Cemetery, Block 98, Lot 12, spaces 1-12 and that the following spaces remain unused: spaces 1, 2 and 4-9 (see attached Exhibit A); 2) That Edna Mae Brown did not file the Deeds for the cemetery spaces with the Washington County Register of Deeds; That Edna Mae Brown died on February 11, 1946 in Blair, Washington County, Nebraska (see attached Exhibit B); -tz. 4) That Pat Long, Cemetery Superinten-dem, perpetual care had been paid on the cemete�y sr-jaces said spaces 1had not been escheated back to the City of Blair; 5) That 1, Dorothy L. Dinkins, am the only surviving child of Edna Mae Brown: 6) That I am requesting that the ownership of transferred into my name so that I can use or sell thie remnainmr --c-ImeT F— spaces. TMUffm J� e. A Dorothy L. Didkins SUBSCRIBED AND SWORN to before me, a lNotary Plud"Alic, on this Gav 2008 by Dorothy L. Dinkins. 0 --A R—k-t OREGON J 2- --- Notary Public ty'f scan traxler 425 582 7271 P. Name I Age Efate W Brown 2/17/1946 5 111 2117/1946 / ?ar'hra 1� 1/ 1 1941 , ware -.. N�iNaE Brow n Edna Mae - - 1 131, 98 LOT 12 GRAVE 10&11 0 : F { L" DATE Off" INTE NT / 17 119 4 6 AGE 5 7 ` (� !9 �4 i7 �_ E E DEATH 2/11/19 _ > _ e �i vn a - I N . B r z - , t. L_ f�.TS } �^' F F_ -z J e� J i i i scan traxler 425 898 7271 WHEN MS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE Q61GlqAL FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES;, VITAL_ OFFICE, WHICH 15 THE LEGAL DEPOSITORY FOR VITAL RECORDS. DATE OF ISSUANCE JUL 2 3 2W8 STANLEY DOP ASSISTANTSTATFREGISTRAR, DEPARTMENT OF HEALTH AND LINCOLN, NEBRASKA HUMAN' SERVICES L if w --;� V � i �, 1) 0- 3 w1g, I Al, Iny Im ,E)KHOUT va 5 -11S�9 (it rwd alp - bmt It fm*hTu bv=. hQW ku-- In U. S. A.?-- M lf WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF`HEALTH AND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS. OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. DATE OF ISSUANCE ` J 2 3 2000 ASSISTANT STATE REGISTRAR DEPARTMENT OF HEALTH AND LINCOLN, NEBRASKA HUMAN SERVICES DEPARTMMqT OF COMMERCE BUREAU OF THE Cl:I+TSUS 1.- PLACE OF (a) County ._.._ (b) City or tov (c) Nash of hi STATE OF E; .. - _ ►, OF 1 1 E ALTH D `( 1 of N Stat r. Social Security or town State File No. (If not in hospital or Institution. Write stmt n (d) hearth of stay: In hospital or institation».,...C_' community __ ............._......._. ,.. ..�_...... (Specify whether yrs.. m a(a) FULL N 2(b) If veteran, name S. Color or 6(a) Single. c .ace.I & divorce 6((b)fX of h nd 6(e) Age of a! . � fe i1 7 Birth dads of (M onth) (Day) { es S. AGE: Years 1 -Months j Days = If less than one day 9. Birthplace_. (City. town, or ;qM; y) (State or foreign country) 10. Usual 11. Industry or biM __.. .. _._ t 112- N n... . ® ............. _..__...... _......._._....... (Cs to or - (State. y1foreign country) . 14, raids n starve _ _ _ ............. li al 15. lBirthplace ......................... ... .s. .. A ft.— c _ i - - _ MEDIC L CERTIFICATION / 20. Date of death: ltlonth _..,....._.da$.... J... 1. .,......39.4 [ hoar. minute. _ __ 21. I hereby certify that I attended the deceased from_____._. to ......... 15 . o that I last ears h.._.._.._alive and that death occurred on the date and hour stated above. Dnratfaa Immediate cause of death- ......—...........m... tam Other (Include pregnan within 3 mouths of _.). PHYSICI" bMaior fisidinga: Underline Of operations ----------- _. _. _.. V_ __ .... _.....____.._.. „_. tm cause .o which death _.._._..._ - -. ............ should be Ofautopsy- _- --_- - -. ._._._. - -.. _- _ ...__ -------- - ....._. »_. - tistieaily. 1 " H death were due to ex`.erual causes, fslI following: S - (t ity or wa m) (` tY) a (State) % id) na sit ., vcLtw Ap__.ur stbout home, an farm. in induszsia_ pL spe ,mss stern traxler 425 898 7271 p.4 Cify of Bid .. Ir 218 Soulthl Blair, Nebrdska '68008 402-426-4191 Fdx' 402-426-4195 EXHIBIT p Pmtr- -L Ong 6 and (� -1 at — GEOFFREY C. HALL / 1664 Washington St. ® P.O. Box 216 Blair, Nebraska 68008 Telephone: (402) 426.4424 Facsimile: (402) 426.4666 January 28, 2009 Linda Traxler 24024 NE 64" CL Redmond, WA 98053 RE: Affidavit of Dorothy L. Dinkins Dear Mrs. Traxler: 238 S. 13th Street Tekamah, Nebraska 68061 Telephone: (402) 374 -2100 Facsimile: (402) 426 -4666 Pursuant to your request, please find enclosed the Affidavit of Dorothy L. Dinkins recorded at the Washington County Register of Deeds office. i have forwarded a copy of the Affidavit to the City Offices for their records. The City records will show that Dorothy is now the owner of the 8 remaining cemetery plots. Please keep in mind that you will still need Quitclaim deeds for each of the remaining plots in order to sell them. I recommend that you retain another attorney to accomplish the Quitclaim Deeds and transfer statements. Sincerely, HALL LAW OFFICES, P.C., L.L.O. Carol Frahm , Assistant to Geoffrey C. Hall /caf Enclosure ,c: Brenda Wheeler:for City of Blair FILED' AFFIDAVIT FOR TRANSFER OF Az, PROPS WI's' OUT PROBATE ZQQ9 J I (' t: ER NEBRASKA PROBATE CODE ` ASti MT ON COUNTY R1r lS1 OF EE The undersigned affiants, upon being first duly sworn, do hereby depose and state: 81-A F, tE 1. The decedents' only real estate located in the State of Nebraska are cemetery plots located in the 'North One -Half of Lot 2 in Block 10, Spaces 4, 5 and 6 in Blair Cemetery, Blair, Washington County, Nebraska" The value of decedents' interest in all real property in both decedents' estates located'in the State of Nebraska does not exceed Twenty -Five Thousand ($25,000.00) Dollars, .a) The claiming successors agree that ownership rights to Spaces 4 and 5 of such : real property shall be granted to Cynthia S. Regier and Ronald R. Regier, husband and wife, Joint Tenants with Right of Survivorship, of 15615 S. Gallery St., Olathe, Kansas 66062. b) The claiming successors agree that ownership rights to Space 6 of such real properly shall be granted to David S. Svendgaard and Rosemary Svendgaard, husband and wife, Joint Tenants with Right of Survivorship, of 14420 Lakeforest Dr. Sun City, Arizona 85351: 2. Thirty (30) days• , have elapsed since the death of both decedents , as shown in certified or authenticated copies of the death certificates of Leland W. Svendgaard ,(date of death July 9, 1988) and Helen M. Svendgaard (date of death April 30i 1989). Both such death certificates are attached to this Affidavit. , 3. No -application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 4. The claiming successors are entitled to the real property by intestate succession since they are, the only surviving children of both decedents. 5. The claiming successors have made an investigation and have been unable to determine any instrument purporting to be the Last Will & Testament of either decedent. 6. No'other person.has a right fo the interest of both decedents and the value of the entire estate of both decedents. 7. The claiming successors swear and affirm that all of the statements in this Affidavit are true and material and acknowledge that any false statement may subject the undersigned to penalties relating to perjury under Nebraska Probate Code Section 28 -915. 8. Pursuant to Nebraska Probate Code Section 30- 24,129 to 30- 24,130, the person paying, delivering, transferring or issuing real property or the evidence thereof pursuant to this Affdavif is discharged and released to the same'extent as if said person dealt with a personal representative of the decedents;• said person'is not required to see to the application of the real property or evidence thereof or to inquire into the truth of any statement in this Affidavit. •t. FURTHER AFFIANT SAYETH NOT. Dated: i a - 1s o �t STATE OF ARIZONA ) ss: COUNTY OF /V6 riccn 5 ) Dated: Subscribed, sworn to and acknowledged before me on this -5 day of j9ece 4,o/ , 2008 by David S. Svendgaard. s lam Qhavez NOTARY PUBLIC •• ARIZONA - MARICOPA'COUNTY My Commission Expires March 10 2012 Notary Public - 1 5Ae A G 4o i t Z My Commission Expires: 03 6 r, / 2fl1 t. FURTHER AFFIANT SAYETH NOT. 4 � STATE OF KANSAS ) ss: COUNTY OF JOHNSON ) U i David S. S ,endgaard Subscribed, sworn to and acknowledged before me on this Cynthia S. Regier. My ty . - 6 a — y of A 008 by Noafa'fy Public Expires: ` ��' Vital Statistics Section CERTIFICATE OF- DEATH. 24087 7 'DECfDiNT -NAME FIRST MIDDLE LAST SEX DATE OF.DEATH (Mo., Day, Yr.) . . Leland Woodrow* Svendgaard 2. Male 3 Julv 9, 1988 RACE- (e.g., White, Black, American (e.g., Italian, Mexican, AGE -Lod birthday UNDER 1 YEAR I UNDER I DAY DATE OF BIRTH (Mo., Day, Yr.) J ORIGINIDESCENT Indian, ek. (Specify) German, etc.) (Specify) (Yrt.) MOB. DAYS HOURS , MINS. A• Yih a Danish ba 75 66. I6c. ,, D e c. .3 1912 CITY AND STATE OF BIRTH (if not in U.S.A.. CITIZEN OF WHAT COUNTRY MARRIED, NEVER MARRIED, NAME OF SPOUSE (ft wife, give maiden name) name country) '. WIDOWED, DIVORCED (Specify) I10• I II. B• Kennard, Nebraska 9, USA Married girjor Kuhr SOCIAL SECURITY NUMBER USUAL OCCUPATION (Give kind of work done during most KIND OF BUSINESS OR INDUSTRY COUNTY OF DEATH 505 -01 -9954 ofworkin I* even ifrefired) ��tY Clerk 1 13M Y - of 12, 13a. Blain 14 a. Dou las CITY, TOWN OR LOCATION OF DEATH INSIDE CITY LIMITS HOSPITAL OR OTHER INSTITUTION -Name (If not fn either, IF HOSP. OR INST. Indicot. DOA, (Specify Yes or No) give ,/reef and number) I Outpotiom /Em.r, Rm., Inpetient (Specify) ; 1460maha 14e. Yes 14d.Montclair Nursing Home 14e. In atient RESIDENCE -STATE COUNTY CITY, TOWN OR LOCATION STREET AND NUMBER INSIDE CITY LIMITS , Ise. Nebraska lsbr Washing tan . 1sc, Blair 1sd.553 No. 2.lst' .(Specify Yet or No) . Ise, Ye FATHER --NAME FIRST MIDDLE LAST MOTHER - MAIDEN NAME FIRST MIDDLE LAST 16. Soren S ndcr 17 .' Anna Madsen WAS DECEASED EVER IN U.S. ARMED FORCES? INFORMANT- NAME - RELATIONSHIP- MAILING ADDRESS (STREET OR R.F.D. NO., C6*OR TOWN, STATE, ZIP) (Yes, no, or unk) (if Yes, give war and dater of service) - 18, No I 19. Cin Re crier (Daughter) 14863 H mks, O ta ha._ ,BURIAL Cremation, Removal) DATE CEMETERY OR CREMATORY -NAME LOCATION CITY OR TOWN STATE 2Da. $ur1a ZOb. July 12, 198 20c. Blair Cemete zed. D lai.. ��rhaS EMBALMER- SIGNATURE b LICENSE NO. FUNERAL HOME -NAME AND ADDRESS (STREET OR R.T.D. NO., CITY OR TOWN, STATE, 2iP) a1�'S "F'cd? J. ,?iman . 4232 22. C. be F DATE OF DEATH (Mo., Day, Yr:) DATE SIGNED (Mo. Day, Yr.) OUR OF' DEA H <� 23a. Jul 9 1988 Z> 4 „0 2 4a. 24b. M , o> •? G DATE SIGNED (Mo., Day, Yr.) HOUR OF DEATH PRONOUNCED•DEAD PRONOUNCED DEAD (Hour) (MP., Day, Yr.) 09 236. 7 -9 -88 _ 23c. 2.3 A M M euj 24c. 24d. To Ike best of my knowledg., death occurred at the lima dole and place and due to the cause(s) rl °tad• _ On the be. ;% of examination and/or investigation, in my opinion death acurred at f ,n � ta_O c the time, dote and place and duo to the cause(:) dated. , 23d.fSf9ntfure and TiHa) S Richard K. Ost'e M. D " 24e. (Signafara and Till.) be ' NAME AND ADDRESS OF CFRTIFIF12 1PIdYSI[IAN. rnRr'jNFD'C PGIYSIr iii no r'f IIWTV ATTnouPV1 n,,.._ ... a.:..,r .. _. '0:4 ..,1. -..A V n -L ._.L -'1 -.._ l.e. x. ir,� .. .� �. • � .. _ ____ __.. _,_ 26a St nafur.) ' 26b JUL ® 27. IMMEDIATE CAUSE t (ENTER ONLY. ONE CAUSE PER LINE FO )V a), (b), AND (e)) i lnfervol between onset ond'dooth. PART ia) Metastatic 6e cinoma Pancreas DUE TO, OR AS A CONSEQUENCE OF: : Intr val'belwean omd and death - (b) DUE TO, OR AS A CONSEQUENCE OF: Int.rrel between omit and dwth PART OTHER SIGNIFICANT CONDITIONS - Conditions contributing to death but not related PART III, IF FEMALE, WAS THERE A AUTOPSY WAS CASE REFERRED TO MEDICAL' II PREGNANCY IN THE PAST3 MONTHS? (Specify Yes or No) . EXAMINER OR CORONER (Specify Yes or No) CA Pro • CAD HBp Yes El No ❑ 1 28, 1 29. t ACCIDENT, SUICIDE, HOMICIDE, UNDET., DATE OF INJURY (Mo., Day, Yr.) HOUR OF 1 W URY DESCRIBE HOW INJURY OCCURRED OR PENDING INVESTIGATION. (Specify) .. ' 30a. 30b, 1 30c. M 1 30d. _ INJURY AT WORK PUCE OF INJURY -At hem., farm, street, focf -Y, LOCATION STREET OR R.F.D. No, CITY OR TOWN STATE. ; (Spocffy Yes or No) office building, etc. (Specify) , 30e. 1 30f. 1 30g. This certifies this document to be a true copy of an original record on file ., with the Vital Statistics Section of the Douglas County Health Depa nt;' Omaha, Nebraska. Certified copies must have a raised seal in the area to the left. Reproductions tof this green certificate-are not legal copies. JUL 2 7 .fig$$' 4 � � c' - .. Date issued: (Registrar) T WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE CQPY- OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR °"- VITAL RECORDS. DATE OF ISSUANCE MAY 1 1 i9 9 STANLEY S. COOPER, DIRECTOR LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS. STATE OF NEBRASKA - DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH S- L '� ' 1. DECEDENT -NAME FIRST MIDDLE LAST 2. SEX 3. DATE OF DEATH /Moon. Day, Yearl Helen Afar orie Svend acrd Female April 30 1989 4. CITY AND STATE OF BIRTH (N not in U.S.A, name coumry/ 5a. AGE - Last Birthday UNDER 1 YEAR NDFP I DAY 16. DATE OF BIRTH (Moon, Day, Year) Sb. MOS. DAYS So, HOURS M.INS. (Yrs.) - .. . T1'1den Nebraska 1 73 1 March 25 1916 7 SOCIAL SECURITY NUMBER 8s. PLACE OF DEATH HOSPITAL• ❑Inpatient El ER /Outpatient ❑ DOA ® y ® 506 °42 -0390 OTHER: XNursing Home ❑Residence 0Other/Speclyl 8b, FACILITY - Name (Ifnot in either, give sheet and number) So. CITY, TOWN OR LOCATION OF DEATH 8d, INSIDE CITY LIMITS Be. COUNTY OF DEATH (Specify Yes or llol , Good Shepherd Hoe Blair Yes Nashin ton , 79. RESIDENCE - STATE 9b. COUNTY 9c, CITY, TOWN OR LOCATION 9d. STREET AND NUMBER (including Zip Codel 9e. INSIDE CITY LIMITS ' ' / Specfy Yes or NO) Nebraska l Washington Blair 2245 Wri ht St. Yes 10. RACE - (e.g.,.Whlte, Black. American Indian, 111. ANCESTRY (e.g.,ttalian, Mexican, German, etc.) 12. MARRIED,NEVER MARRIED, - 13. NAME OF SPOUSE (N wile, give maiden name) etc.) (Specify) (Specify) WIDOWED, DIVORCED (Specify) White. Danish- German Vidoved Leland.N.3vend aard.. 14a. USUAL OCCUPATION (Give kind of work done during most 14b, KIND OF BUSINESS INDUSTRY ni aladl 'Elementary or Secondary (0.12) 1 College 11.4 or 5 +) of working file, even grellredl Bookstore Mana er .Dana Co11e a 12 16. FATHER - NAME. FIRST MIDDLE LAST 17. MOTHER - MAIDEN NAME FIRST MIDDLE LAST Herman. C. Kuhr . ': Hannah Nelson y " 18. WAS* DECEASED EVER IN U.S. ARMED FORCES? 19. INFORMANT - NAME - MAILING ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN, STATE, ZIP) (Yes, he, or unit.) pt yes, give war and dates of services) No' 11 ' ' Leland 3vend aard Son 8707 Parker Oiaha' Ne.- •: 20a. BURIAL; Cremation,Removal, 20b. DATE 20c, CEMETERY OR CREMATORY - NAME 20d. LOCATION CITY OR TOWN STATE Donation ..Burial 5 -5 -1989 Blair Cemetery Blair Ne., 21. EMBALMER - SIGNATURE b LICENSE NO. 22 FUNERAL HOME - NAME AND ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN, STATE, ZIP) 23. IMMEDIATE CAUSE �t (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), AND (c)) I Interval between onset and death PART DUE TO, OR AS A CONSEQUENCE OF: 1 Interval bAlw n onset and death r � I DUE TO, OR AS A CONSEQUENCE OF: 1 Interval boween onset and death I OTHER SIGNIFICANT CONDITIONS - Conditions contributing to death but not related PART Ill IF FEMALE, WAS THERE A 24, AUTOPSY WAS CASE REFERRED TO MEDICAL PART PREGNANCY IN THE PAST 3 MONTHS? (Specify Yes or Nol EXAMINER OR CORONER? II Mlr 1 25. (Specifyy Yes or No) Yes ❑ NoA 26a. ACCIDENT, SUICIDE, HOMICIDE, UNDET., 2 DATE OF INJURY (Mo.,Day, Yr) 26c. HOUR OF INJURY 26d. DESCRIBE HOW INJURY OCCURRED OR PENDING INVESTIGATION (Specify) . 26e. INJURY AT WORK 26f. PLACE OF INJURY - At home, farm, street. factory, 26p. LOCATION STREET OR R.F.D. NO. CITY OR TOWN STATE ( Specit Yes or Nol office building, etc. (Specityl 27a. DATE OF DEATH (MO., Day, Yr.) 28a. DATE SIGNED (Mo., Day, Yr.) 28b. TIME OF DEATH 1 Qr VY 27b. DATE SIGNED /Mo., Day, r.) TIME OF DEATH 28C. PRONOUNCED DEAD (Mo., Day, Yr.) 28d. PRONOUNCED DEAD /Hour) • : Tit L 1 . 2 . 7c. . • • d - • : t ,, '-.. 27d. To the of my knowledge, death occurred at the time, data and ace and due the W 2Be. On the basis of examination and/or investigation, In m nlon death occurred et 9 y oW :8 �- ,. cause(s) stated, , ,.•., ,;..• �: 25 is the time, date and place and due to the causes) ale ' ced. • . ' (Signature and T44) - ... _.. _ . ( Signature and Title) - ' 29a. DID TOBACCO USE CONTRIBUTE TO THE DEATH? 30a. HA R AN OR TISSUE DONATION BEEN CONSIDERED? 30b. WAS CONSENT GRANTED? ❑ YES �1i0 ❑ UNKNOWN ❑ YES �' NO ❑ YES 1 440 . • 31. NAME AND ADDRESS OF CERTIFIER (PHYSICAN, CORONER'S PHYSICAN OR COUNTY ATTORNEY) (Type or Print) s tZ b, ( e rt r b 763 W, asst 11 dp eD 32a. REGISTRAR 3W DATE FILED BY REGISTRAR. (MO., Day, Yr.) .. MAY 3 , 1999 IV Block --- - - - - - ---- - - - - -- Lot------ 2 ------ - - - - -- Sps. Sold to Date Lot 2 Blk. 10 Sp. 1 Sps. 4_9 Lot 2 Blk. 10 �Sold to PC PAID Leland & Helen Svendgaa Date 1 4 / 1 998 Al .5t +,ut� 2 — 3 4 — Sps. 6 Sold to Transfer by David S & Rosemary Date 12,/29/2008 Lot 2 Blk. 10 affidavit t Svendgaard JTWROS 5 6 — 7 Sps. 4. &, 5 Lot 2 Blk. 10 Transfer by affidavit to Sold to Cynthia S &Ronald R.Regierr Date 12/29/2008 JTWROS 8 - - g — Sps. Sold to I Date — Lot Blk. 10 — 11 12 t Name Age I Date Helen Ma orie Svendgaard 5/3/89 L W Sven aard 7/12/1988 K D 9/19/1943 Walter Svend aard reburial from Kennard) " I c Block -- - - - - -A ............. Lot. ----- 2------------ Sps. Lot 2 Bilk. 10 Sp Name Age Date 1 Sold to Date 2 Sps. 4 -9 Lot 2 Blk.10 Sold to PC PAID 7'1i€ lts 4 Leland & Helen Svendgaard 3 4 Date 9 1 4 1 9 5 g .�.pu 5 Sps. Lot Blk. 6 Sold to 7 Helen Ma orie Svendgaard 5 1 4 3/8 9 Date S s. Lot Bik. _ Sold to $ _. L W Sven aard 7/ 12/1988 D 9/19/1943 Date 9 Walter Svend aard reburial from enn rd 10 Sps. Lot Bilk. Sold to 11 12 Date F (402) 333 -10 a Phone (402) 330 -8001 a r>tritr A b3pa Attorney at Law r, 1 0544 Old N1111 Road, Suite 5 Omaha, Nebraska 68154 . , Name | Age | Date 1 Sold to Date 2 Sold to Leland PC PAID 11 & Helen Svendgaar 3 Date Rs000 Sold to 6 7 Date Sold to Date Sold to 11 12 Date Name | Age | Date A. FILED AFFIDAVIT FOR TRANSFER - OF REAL PROPER WIT-ROUT PROBATE 809 JAN -21 PM k4 UNDER NEBRASKA PROBATE CODE KAME WASH110T0 COUNTY bs REGIST 1, OF DEEOO The undersigned affiants, upon being first duly sworn, do hereby depose and state: B .A, . 1. The decedents' only real estate located in the State of Nebraska are cemetery plots located in the "North One -Half of Lot 2 in Block 10, Spaces 4, 5 and 6 in Blair Cemetery, Blair, Washington County, Nebraska ": The value of decedents' interest in all real property in both decedents' estates located'in the State of Nebraska does not exceed Twenty -Five Thousand ($25,000.00) Dollars. a) The claiming successors agree that ownership rights to Spaces 4 and 5 of such real ` property shall be granted to Cynthia S. Regier and Ronald R. Regier, Husband and wife, Joint Tenants with Right of Survivorship, of 15615 S. Gallery St., Olathe, Kansas 66062. b) The claiming successors agree that ownership rights to Space 6 of such real property shall be granted to David S. Svendgaard and Rosemary Svendgaard, husband and wife, Joint Tenants with Right of Survivorship, of 14420 Lakeforest Dr. Sun City, Arizona 85351: 2. Thirty (3 0) days . have elapsed since the death of both decedents. as shown in certified or authenticated copies of the death certificates of Leland W. Svendgaard ,(date of death July 9, 1988) and Helen M. Svendgaard (date of death April 30; 1989). Both such death certificates are attached to this Affidavit. 3. No : application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 4. The claiming successors are entitled to the real property by intestate succession since they are, the only surviving children of both decedents. 5. The claiming successors have made an investigation and have been unable to determine any instrument purporting to be the Last Will & Testament of either decedent. 6. No. other person. has a right to the interest of both decedents and the value of the entire estate of both decedents. 7. The claiming successors swear and affirm that all of the statements in this Affidavit are true and material and acknowledge that any false statement may subject the undersigned to penalties relating to perjury under Nebraska Probatd Code Section 28 -915. S. Pursuant to Nebraska Probate Code Section 30- 24,129 to 30- 24,130, the person paying, delivering, transferring or issuing real property or the evidence thereof pursualit to this Affidavit is discharged and released to the same 'extent as if said person dealt with a personal representative of the decedents; said person . is not required to see to the application of the real property or evidence thereof or to inquire into the truth of any statement in this Affidavit. FURTHER AFFIANT SAYETH NOT. Dated: i a, - 1e— o cj STATE OF ARIZONA ) ss: COUNTY OF Ma 5 ) i David S. S ,endgaard Subscribed, sworn to and acknowledged before me on this day of Pec.e k, 4 : p/ , , 2008 by David S. Svendgaard. qee Qhavez NOTARY PUBLIC •• ARIZONA _ MARICOPA COUNTY My Commission Expires March 10, 2012 My Commission Expires: 03 /r U / 2.oi z FURTHER AFFIANT SAYETH NOT. Dated: I n STATE OF KANSAS ) ss: COUNTY OF JOHNSON ) I Notary Public - 5AoA G 4-�-c z Subscribed, sworn to and acknowledged before me on this Cynthia S. Regier. a a�y of 08 by \: NoAdv Public s r My Expires: Vital Statistics Section CERTIFICATE OF DEATH. zoos 'DECEDENT -NAME FIRST MIDDLE LAST SEX DATE OF.DEATH (Mo., Day, Yr.) Leland Woodrow Svendgaard Ma- 9, 1988 1 . 2, 3 . July RACE- (e.g., White, Black, American ORIGIN /DESCENT (e.g., Italian, Mexican, AGE -tart Birthday UNDER I YEAR! UNDER 1 DAY DATE OF BIRTH (Mo., Day, Yr.) MOS. DAYS HOURS . MINS. Indian, ek. (Specify) German, etc.) (Specify) (Yrs.) I . t�hate s Dan 6a. 75 66. I6c. (b) .. 7. Dec. .3 1912 CITY AND STATE Of BIRTH ()f not in U.S.A., CITIZEN OF WHAT COUNTRY NEVER MARRIED, NAME OF SPOUSE (ffwife, give maiden name) name country) l==D, DIVORCED (Specify) 1 B. K ennard, Nebraska , 9. USA 10. Married & ijkr ' or Kuhr SOCIAL SECURITY NUMBER USUALOCCUPATION (Give kind of work done during most KIND OF BUSINESS OR INDUSTRY COUNTY OF DEATH 505 -01 -9954 of working IZe y Clerk 1 13MY Blau' EXAMINER OP. CORONER 12. 13a. Of 140. Doucr as CITY, TOWN OR LOCATION OF DEATH INSIDE CITY LIMITS I HOSPITAL OR OTHER INSTITUTION- Name (ff not in eilber, IF HOSP. OR INST. Indicate DOA, • 1 14c. (Specify Yes or No) give street and number) Outpotient /Eme r. Rm., Inpatient (Specify) 14bomaha Yes T4d.Montclair Nursinq Home 14e. Ini3atient ' RESIDENCE -STATE COUNTY CITY, TOWN OR LOCATION STREET AND NUMBER IT LIMIT INSIDE CITY LIMITS 30a. 3Gc. (Specify Yes lsa. Nebraska 1sb, Washin ton IsP,. Blair 1sd.553 No. 2.lst m.. Ye FATHER -NAME FIRST MIDDLE LAST MOTHER - MAIDEN NAME FIRST MIDDLE LAST 16. Soren S ndcrard 1 17. Anna Madsen WAS DECEASED EVER IN U.S. ARMED FORCES? INFORMANT- NAME - RELATIONSHIP- MAILING ADDRESS (STREET OR R.F.D. NO„ CITY Olt TOWN, STATE, ZIP) (Yes, no, or unk) (If yes, give war and doter of service) 18, No I 19. Cind Re i.er ( Daughter) 14863 Harve E Omaha, A BURIAL, Cremation, RemovallDATE CEMETERY OR CREMATORY -NAME LOCATION CITY OR TOWN STATE 20a. Burial 1 20b. July 12, 198 2Dr. Blair Cemetery 1 20d. B lair , 1`eb - Yask a _ EMBALMER - SIGNATURE d LICENSE NO. FUNERAL HOME -NAME AND ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN. STATE, ZIP) 21�J - Ft6de J. Aman 4232 22. Cambell F' Ant. M. DATE OF DEATH (Mo., Day, Yrj Day, Yr.) H OUR OF DEA H ou 23a. July 9 1988 24a. 24b. M �NO >k DATE SIGNED (Mo., Day, Yr.) HOUR OF DEATH PRONOUNCED DEAD PRONOUNCED DEAD (Hour) o o 'n : c (Mo„ Day, Yr.) , a 23b. • 7 -9 -88 23a 2 :30 A M M UtZ 24c. 24d. ' To the best of my knowledge, death occurred at the time, dote and place and due to the On the b-it of examination and/or investigation, I. my opinion death occurred at y s e 0 O �` cause(c) Aated. t°-O c the time, date and place and due to the causes) staled. 23d.(Mgnaf.re and Tit(.) s Richard K. Osterholm M. D " 24e. (Signature and Till.) 1111- NAME AND ADDRESS OF CERTIFIER (PHYSICIAN. CORONER'S PHYSICIAN OR COUNTY ATTORNEY) (Tvoe or Print) This certifies this document to be a true copy of an original record on file ... with the Vital Statistics Section of the Douglas County Health Department Omaha, Nebraska. Certified copies must have a raised seal in the area to the left. Reproductions of this green certificate are not legal copies. JUL 2 7 1988 l � Date issued. (Registrar) JUL 1 5 1988 26b.' ® 27. 'IMMEDIATE CAUSE (ENTER ONLY. O NE CAUSE PER LINE FO a), (b), AND (e)) i Intenof between once# and death. PART I.) Metastatic Carcinoma Pancreas DUE TO, OR AS A CONSEQUENCE OF: i Interval'between once# and death i (b) .. DUE TO, OR AS A CONSEQUENCE OF: Inte vai be v... wait and death t (c) PART OTHER SIGNIFICANT CONDITIONS - Conditions contributing to death but not related PART III. IF FEMALE, WAS THERE A AUTOPSY WAS CASE REFERRED TO MEDICAL' PREGNANCY IN THE PAST 9 MONTH57 (Sp.cNy Yer or No EXAMINER OP. CORONER 11 1 28. (Specify Yes or No) CA Prostate CAD HBP Yes ❑ No El 29, ACCIDENT, SUICIDE, HOMICIDE, UNDET., DATE OF INJURY (Mo., Day, Yr.) HOUR OF I W URY DESCRIBE HOW INJURY OCCURRED OR PENDING INVESTIGATION. (Speufy) 1 306. 30a. 3Gc. M 30d. - INJURY AT WORK PUCE OF INJURY' - At home, farm, street, factory, LOCATION STREET OR R.F.D. No, _ CITY OR TOWN ., 15TATE. (Specify Yes or No) effin building, etc. (Spocily) 1 30f. 1 30g. 30e. This certifies this document to be a true copy of an original record on file ... with the Vital Statistics Section of the Douglas County Health Department Omaha, Nebraska. Certified copies must have a raised seal in the area to the left. Reproductions of this green certificate are not legal copies. JUL 2 7 1988 l � Date issued. (Registrar) r 6 WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE CQPY. OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR - VITAL RECORDS. DATE OF ISSUANCE MAY I 1 1989 STANLEY S. COOPER, DIRECTOR LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS. STATE OF NEBRASKA - DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH 4 1. DECEDENT - NAME FIRST MIDDLE LAST 2. SEX 3. DATE OF DEATH (Month, Day, Year/ Helen Mar orie Svend acrd Pena e April 30 1989 4. CITY AND STATE OF BIRTH (Bxl m U.S.A., name country/ 5a. AGE -Last Birthday N R 1 A (Yrs.) 5b. MOS. DAYS 1 6. DATE OF BIRTH (Month, Dey. Year) 5c: HOURS MINK - - Tilden Nebraska 73 March 25 1916 7. SOCIAL SECURITY NUMBER 8a. PLACE OF DEATH HOSPITAL: El inpatient O ERlOutpatieM 11 DOA - 506 -42 - 0340 OTHER: Nursing Home O Residence ❑ other(Specify) 8b, FACILITY - Name (Brat in either, give street and number) Bc. CITY, TOWN OR LOCATION OF DEATH 8d, INSIDE CITY LIMITS Se. COUNTY OF DEATH (Specify Yes or No) . Good She herd Hole Blair Yes Washin ton 9a. RESIDENCE - STATE 9b. COUNTY 9e. CITY, TOWN OR LOCATION 9d. STREET AND NUMBER (Ixludkrg Zip Coda) Be. INSIDE CITY LIMITS ' /SpecrfyYes or No) r Nebraska Washington Blair 2245 Wright St. Yes 10. RACE - (e.g.,. White, Black American Indian, 11. ANCESTRY (e.g.,halian, Mexican, German, etc.) 12. MARRIED,NEVER MARRIED, 13. NAME OF SPOUSE (B wile, give maiden name) etc.) (Specify) (SpecM WIDOWED, DIVORCED (SpecByJ White I Danish- German �, K1doved Leland. .Svend aard 14a. USUAL OCCUPATION (Give kind 61 work done during most 14b. KIND OF BUSINESS INDUSTRY 1 T hi r l eledl "Elementary or Secondary (0.12) I College 11.4 or 5 +1 of working life, even if refired). I. Bookstore Manager Dana Colle a 12 16. FATHER- NAME.. FIRST MIDDLE LAST 17. MOTHER - MAIDEN NAME FIRST MIDDLE UST Herman. C. Kuhr. Hannah Nelson 1B. WAS DECEASED EVER IN U.S. ARMED FORCES? , . 19. ,INFORMANT - NAME - MAILING ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN, STATE, 21P) (Yes, no or unk.) (It yes, give war and dates of services( , Ne." '' Leland 3vend aard Son 8707 Parker Oiaha No f 20a. BURIAL; Cremation,Removal, 20b. DATE 20c, CEMETERY OR CREMATORY - NAME 20d. LOCATION CITY OR TOWN STATE Donation Burial 5 -5 -1989 Blair Ce eter Blair Ne._ " 21. EMBALMER - SIGNATURE 8 LICENSE NO. 22. FUNERAL HOME - NAME AND ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN, STATE, ZIP) 3 / L ✓�/ ' 23. IMMEDIATE CAUSE V JENTER ONLY ONE CAUSE PER LINE FOR (a), (b). AND (c)) I . Imerval between onset and death I PART I I I / I Interval een onset and death DUE TO, OR AS A CONSEQUENCE OF: I ,//J - r��� f DUE TO, OR AS A CONSEQUENCE OF: I Interval n onset and death I I REFERRED TO OTHER SIGNIFICANT CONDITIONS - Conditions contributing to death but not related ART III I PR IN THE PAST 3 MONTHS? 24 % U peciry Yes or NoJ 25 EXAMI OR ORONER? MEDICAL MALE, WAS THERE A PART (Specify Yes or No) II / v'� Yes [) No 26a. ACCIDENT, SUICIDE, HOMICIDE, UNDEf., 26b. DATE OF INJURY /Mo.,Day, Yr.. J 26c. HOUR OF INJURY 26d. DESCRIBE HOW INJURY OCCURRED ' OR PENDING INVESTIGATION (Specify) 26e. INJURY AT WORK 261. PLACE OF INJURY - At home, farm, street rectory, 26g. LOCATION STREET OR R.F.D. NO. CITY OR TOWN STATE (Specify Yes or No) office building, etc. (Specify) ,. 27a. DATE OF DEATH (Mo., Day, Yr.) 28a. DATE SIGNED (Mo., Day, Yr.) 28b. TIME OF DEATH J 27b. DATE SIGNED (Mo., Day. c/ 27c. TIME OF DEATH 20c. PRONOUNCED DEAD (Mo.. Day, Yr.) 28d. PRONOUNCED DEAD (Hour) ` } B .... .. data and due the E.ln Z .°- .. ... .. . 28e. On the basis of examination investigation, in my opinion death occurred at 27d. To the of my knowledge. death occurred al Me time, end place due to the lima, data and place and due to the causes) stated. ; .. cause(s) stated, , (Sf nature aril Ti1M - (Signature and Title) - 29a. DID TOBACCO USE CONTRIBUTE i0 THE DEATH? OR TISSUE DONATION BEEN CONSIDERED? 3Db. WAS CONSENT GRANTED? � 30& _ HA06R&AN ❑ YES XNO ❑ UNKNOWN OYES �' NO ❑YES 31, NAME AND A DDRESS OF CERTIFIER (PHYSICAN, CORONER'S PHYSICAN 08 COUNTY ATTORNEY) (Type or Print) 7 S 3 /y /sf 941 1 328. REGISTRAR 3& DATE FILED BY REGISTRAR (Mo., Day, Yr.) ' _ : _ . _ -_ M AY 3 1999 A . -�ODW6 33 0 WASHINGTON COUNTY, STY-TE OF NEBRASKA RECORDED qtr ATi / BOOK ' —PAOE(S) 3 REGISTER OF DEEDS - 4�- ASKA DOC - UM NTAiiv T/ -'QP TAX Date 4a� tat - Al ' voy $ E / By 6�j QUITCLAIM DEED F1, L-"� 2000 AUG 21 PM I: I I KAREt°,` ,A, NA1AD8EN WASHIIiiGTON COUNTY REGISTER OF DEEDS 8 L Via. I , NE CORINNE D. DeJARNETT, a Single Person, Grantor, whether one or more, in consideration of ONE DOLLAR ($1.00) and other valuable consideration, receipt of which is hereby acknowledged, quitclaims and conveys to CITY OF BLAIR, NEBRASKA, Grantee, the following described real estate (as defined in Neb. Rev. Stat. § 76 -201) in Washington County, Nebraska: Grave Spaces 4, 5 and 6 in Lot 2, Block 61 of the Blair Cemetery located in the Northeast Quarter of the Northeast Quarter (NE1 /4 NE1 /4) of Section Twelve (12), Township Eighteen (18) North, Range Eleven (11), East of the 6' P.M., Washington County, Nebraska. Executed: July 30, 1999. STATE OF NEBRASKA COUNTY OF WASHINGTON ORINNE D. DeJARNETT The fore going b instrument was acknowledged before me ors July 30, 1999, by CORINNT E D. b DeJARNETT. Not Public 48ERAlNO��RY �tate�AN��jska GE GD �oq�� E. 2001 111 �Y Comm. EaP• pAacch t0, I County Name 2 County 4umber 3 Date of Sale Mo. Day Yr. 14 Date of Deed Mo. Day -Yr. Is Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print) Grantor's Name (Seller) U Grantee's Name (Buyer) Street or Other Mailing Address Street or Other Mailing Address City State Zip Code city State Zip Code Telephone Number Telephone Number PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home. Status I (B) Property Type I (C) (1)1 1 Improved (2)F Unimproved (3)❑ IOLL (1)L_j Single Family (2) E] Multi-Family 1(3)❑ Commercial (4) Lj Industrial (5) ❑ Agricultural (6) lJ Recreational (u) Lj Mineral interests- (9) Lj btate Assessea (1) Lj MODHe mome (7) Mineral Interests- Producing (10) [:] Exempt Nonproducing 8 Type of Deed F warranty F Quit Claim F Sheriff ❑ Conservator ❑ Executor ❑ Partition F1 mineral El cemetery ❑ Trust ❑ Other P , g' V M 1 ­11 10 Type of Transfer ❑ Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain) 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 $ - % Does this conveyance divide a current parcel of land? 17 ❑ YES ❑NO DYES ❑ NO Was sale through a real estate agent? (it Yes, name or agent) Address of Property 19 Name and Address of Person to Whom Tax Statement ShOUla be sent 20 Legal Description 6 21 If agricultural, list total number of acres 22 Total purchase price, including any liabilities assumed ............................................. 22 $ 23 Was nonreal property included in purchase? ❑ YES E:1 NO (if Yes, enter amount and attach itemized list ) .. 23 $ 7"W - $ 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 I am duly authorized to sign this statement. 25 sign hp.rp. Type Name of Grantee of Grantee or Authorized Telephone Number Title Date I REGISTER OF DEEDS' USE ONLY FOR NDR USE ON 26 Date Deed Recorded Mo. - Day Yr. 27 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page 30 Nebraska Department of Property Assessment & Taxation Authorized by sections 76-214, 77-1327, R.R.S. 1943 Form No. 2-146-67 Rev. 12-00 Supersedes 2-146-67 Rev. 9-94 NEBRASKA DEPARTMENT OF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy pnnW with soy Ink on recycled paper ❑ YES ❑ NO ❑ Spouse ❑ Parents and Child ❑ Family Corporation or Partnership ❑ Grandparents and Grandchild [:] Brothers and Sisters ❑ Aunt or Uncle to Niece or Nephew ❑ STATE OF NEBRASKA ) ) :ss: AFFIDAVIT COUNTY OF WASHINGTON ) CORINNE D. DeJARNETT, being first duly sworn on oath, deposes and says that she and Tollie L. DeJarnett were wife and husband, and that she is the surviving spouse of Tollie L. DeJarnett who died , 1999, and that a copy of the Certificate of Death for Tollie L. DeJarnett is attached hereto, marked Exhibit "A" and by this reference made a part hereof. Affiant further deposes and says that Tollie L. DeJarnett and Corinne D. DeJarnett, husband and wife, were the owners in joint tenancy of the following described real estate, to -wit: Grave Spaces 4, 5 and 6 in Lot 2, Block 61 of the Blair Cemetery located in the Northeast Quarter of the Northeast Quarter (NE 1 /4 NE 1/4) of Section Twelve (12), Township Eighteen (18) North, Range Eleven (11), East of the 6 P.M., Washington County, Nebraska and that, upon the death of the said Tollie L. DeJarnett, the undersigned, Corinne D. DeJarnett, became the sole owner of said real estate by operation of law. Dated this 30" day of July, 1999. CORINNE D. DeJARNE SUBSCRIBED AND SWORN to before me this 30' day of July, 1999. otary Public rENERAL NOTARY•� of Nebraska III EDMOND ALBOT L My C omm. UP ch 10, 2001 a �y V r or ['1 or Number To I 6 Q.. Q9 CITY OF BLAIR, NEBRASKA Claim Date Voucher Number Check Number F T = , City Clerk Finance Committee Approval: 1 do solemnly swear that the above account is true and correct to the best of my knowledge. Subscribeid and sworn to before me thi day of 19_ ,o08030YO WASHINGTON COUNTY, STME OF NEBRASKA RECORDEDq ! -oOf AT l SCo BOOK 9 PAGES) 1 - S '� r p,1 OF DEED TINS QUITCLAIM DEED, Executed this '� a N d (Yea'), o� ® ® F r by first parry, Grantor, W® sew! V whose post office address is 7 9 ll to second party, Grantee, (2 ) T ® P whose post office address is � IA �� NEBRASKA DOCUMENTARY STAMP TAX Data 31, $ e m pt IO B (i?) F! M FE. D 2000 JUL 31 PM 12= 1 4 U KARLEN A. MADSEN WAS1i114GTON COUNTY REGISTE -P OF DEEDS BLAIR, NEE day of J "'L y , . 1B ALL, 4 - �)e /®�e es / V- l Ail J 4 LL ( O � ,4 A//q NT TNESSETH, That the said first party, for good consideration and for the sum of Dollars ($ �o® ° G ) paid by the said second parry, the receipt whereof is hereby acknowledged, does hereby remise, release and quitclaim unto the said second party forever, all the right, title, interest and claim which the said first party has in and to the following described parcel of land,. and improvements and appurtenances thereto in the County of r G -M W, State of / V-e B- 'S K to wit: 046� �FAC'e5 [Signatures on following page.] Page 1 of 2. Initials of First Party SM IN WITNESS WHEREOF, The said first parry has signed and sealed these presents the day d and delivered in presence of: Signature of Fir t Party, rantor Print name of First Party Signature of First Pa Grantor I) l0 S J. r'4z Print name of First Parry STATE OF 0 /) �,1G/-) COUNTY OF 11 On UJ before me, To �n appeared �'� � � S � � CG e� 0, + AW personally known to me ( proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized capacity(ies), and that by his /her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Page 2 of 2. Print Name of Preparer Address of Preparer Initials of First Party MIUMM; EMW (JuLSA7- Print name Witness ! `�; u f GENERAL =NOTARY � Affiant Known Produced ID Type of ID AJL • (_ TO BE FILED WITH REGISTER OF DEEDS R ea l E s t a t e T rans f er St a t emen t ® Read instructions on reverse side F ORM THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 -25 ARE AC CURATELY COMPLETED 1 County Name 2 County Number 30 3 Date of Sale Mo. Day Yr. 4 Date of Deed Mo. Day ` Yr. 5 Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print) Grantor's Name (Seller) Grantee's Name (Buyer) Street or Other Mailing Address Street or Other Mailing Address City State Zip Code City State Zip Code Telephone Number Telephone Number 7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if Property is mobile home. ( A) Status (B) Property Type (C) (1)❑ Improved (2)❑ Unimproved (3)❑ IOLL (1)❑ Single Family (4) ❑ Industrial (2)❑ Multi- Family (5) ❑ Agricultural (3)0 Commercial (6) ❑ Recreational (8) ❑ Mineral Interests- (9) [] State Assessed (7) ❑ Mineral Interests- Producing (10) ❑ Exempt Nonproducing (1) ❑ Mobile Home 8 Type of Deed ❑ Warranty ❑ Sheriff ❑ Executor ❑ Quit Claim ❑ Conservator ❑ Partition ❑ Mineral ❑ Cemetery ❑ Trust ❑ Other 10 Type of Transfer El Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain) 110 h' Transferred ' F ll (if N I' division ) Ownership in Full o, explain 12 W I estate purchased f ? ('f N state intended use) ],YES ❑ NO ❑ YES ❑ NO Yes, Was real a e pure ase or same use. i o, s a e YES ❑ NO ❑ Spouse ❑ Parents and Child ❑ Family Corporation or Partnership ❑ Grandparents and Grandchild ❑ Brothers and Sisters ❑ Aunt or Uncle to Niece or Nephew ❑ Other 141f 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 DYES ❑ NO 18 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 ............. ............................... 22 23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) .. 23 24 Adjusted purchase price paid for real estate (line 22 minus line 23) ...... Linden penalties of lave, 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. r 25 sign here Print or Type Name of Grantee or Authorized Signature of Grantee or Authorized Representative Title Date REGISTER OF DEEDS' USE ONLY FOR NDR USE ONL 26 Date Deed Recorded Mo. Day , Yr. F27 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page 30 Nebraska Department of Property Assessment & Taxation Authorized by Sections 76 -214, 77 -1327, R.R.S. 1943 Form No. 2- 146 -67 Rev. 12 -00 Supersedes 2- 146 -67 Rev. 9 -94 0� NEBRASKA DEPARTMENT OF REVENUE —White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy printed with soy ink on recycled paper Q 00y0a51.5" ASH'NGTON COUNTY, STATE OF NEBRASKA RECORDED AT -3S M. BOOK S PAGES) P,EGISTER OF DEEDS o NEBRASKA DOCUMENTARY STAMP TAX Date 01 j, rJ� 1k, �DD�' $ , t* wsy WARRANTY DEED 2008 JUN 18 AM I I *- 35 KAREI A. MADSEN WASHINGTON COUNTY REGISTE OF DEEDS BLAIR, NE THAT Judith E. Watanabe and Mike.M. Watanabe, wife_ and, husband, Grantor, in consideration of one dollar ($1.00) and other valuable consideration received from the City of Blair, Washington County, State of Nebraska, Grantee, do hereby grant, bargain, sell, convey and confirm unto Grantee the following described real property: Grave spaces 3, 4, 5, and 6 in Lot No. 12, Block 42 of the Blair Cemetery located in the Northeast Quarter of the Northeast Quarter (NE' /4 NE' /4) of Section Twelve (12), Township Eighteen (18) North, Range Eleven (11) East of the 6" P.M., Washington County, Nebraska. To have and to hold the above described premises together with all tenements, hereditaments and appurtenances thereto belonging unto the Grantee and to Grantee's heirs and assigns forever. And the Grantor does hereby covenant with the Grantee and with Grantee's heirs and assigns that Grantor is lawfully seised of said premises; that it is free from all encumbrances; that Grantor has good right and lawful authority to convey the same; and that Grantor warrants and will defend the title to said premises against the lawful claims of all persons whomsoever. DATED this ? Vt�l day of _ ^ ,�w.� _ , 2008. Judith E. Watanabe Recorde General Numerical Photostat Proofed Mile M. V.'atanabe ;ed before me on the ! 1 1 day of and husband. 2008, by Notary Public GROW NOTARY •State of Nebraska BLAOMQUIST 4 Comm. UCp. Aup, i, 2Ut1 5808 Briggs Street Omaha, NE 68106 June 23, 2008 Mr. Pat Long Cemetery Superintendent City of Blair 218S.16 1h Street Blair, NE 68008 Dear Mr. Long: Attached are the copies of a Warranty Deed and Real Estate Transfer Statement, which were mailed to Brenda Wheeler on June 19, 2008. These are for sale of grave spaces 3, 4, 5, & 6 in Lot 12, Block 42 of the Blair Cemetery. The Warranty Deed was recorded on June 18. As previously discussed, we are to receive $200 per grave space or a total of $800 for this sale. If you have any questions, please contact me at 402 -558 -1077 or Kathy, Blair City Hall, 426 -4191. Thank you. Sincerely yours, Judith E. Watanabe TO BE FILE Rea 5I, Z Tr 4 a` Y e nt FO RM WITH REGISTER Read instructi a n OF DEEDS 521 r. E %UI LL - 00T BE RECORDED U ;I s AN D COMPLETED 1 County Name 2 County Number 3 Date of Sale 4 Date of Deed - 30 Mo. Day Yr.: Mo. Day Yr. Mo. Day Yr. Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Nacre, Address, and Telephone (Please Print) Grantor's. Name (Seller) Grantee's Name (Buyer) Street or Other Mailing Address Street or Other Mailing Address - - t City State Zip Code City State Zip Code Ril U Telephone Number Telephone Number 4 7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home. (A) Status (8) Property Type (C) (1)❑ Improved (1)❑ Single Family (4) ❑ Industrial (6) ❑ Recreational (8) ❑ Mineral Interests- (9) ❑ State Assessed (1) ❑ Mobile Home (2)❑ Unimproved (2)❑ Multi - Family (5) ❑ Agricultural (7) ❑ Mineral Interests- Producing (10) ❑ Exempt (3)❑ IOLL (3)0 Commercial Nonproducing 8 Type of Deed Warranty E] Sheriff ❑ Executor ❑ Mineral ❑'Cemetery ❑ Quit Claim ❑Conservator ❑Partition ❑Trust ❑Other 10 Type of Transfer 2 Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Other (explain) 11 Ownership Transferred in Full (if No, explain division) 12 Was real estate purchased for same use? (if No, state Intended use) Ej YES ❑ NO E]; YES ❑ NO ba V-3 JGI ­Vv a lowuvc 1 t11 lo,'nc app, vNuaw ­j ❑ YES ❑NO ❑ Spouse ❑ Parents and Child ❑ Family Corporation or Partnership ❑ Grandparents and Grandchild ❑ Brothers and Sisters ❑ Aunt or Uncle to Niece or Nephew ❑ O 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? ° tj ❑ YES Q= 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 ;Ej NO Address of Property Name and Address of Person to Whom Tax Statement City BIVIIr 21 S. 16th S t.. 20 Legal Description u ps g3,1'�ri 3, 4 w, amd 6 ill Lot No,, 12, Bloxk ark olf* the 1" 3 :, Cani er"' 00 --at- d 1 the __. -' toy. 01, the- N- 0r=.i'1aAE ¢ u"i I •tom.: IF i t NE" j rs.7f io-,I Twt :d ve {, 2, ioh ip F J' g'h th0-` -i3 i 1 2 , na �° - �, cis. `...143 i' - -- Hi l "fv y t otr`wre;v 21 If agricultural, list total number of acres 22 Total purchase price, including any liabilities assumed , ...... I .......................... I .... I .... 22 $ 23 Was nonreal property included in purchase? ❑ YES -IN NO (if Yes, enter amount and attach itemized list) .. 23 $ 24 Adjusted purchase price paid for real estate (line 22 minus line 23) .... ........................... 24 >i 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 I am duly authorized to sign this statement. ® Print or Type Name of Grantee or Authorized Representative sign h ere Signature of Grantee or Authorized Representative Title 26 ;1 t Telephone Number 5 kt ' D'S Date REGI STER OF DEEDS' USE ONLY FOR NDR USE ONL 26 Date Deed Recorded , 27 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page 30 Mo. Day Yr.: - Nebraska Department of Property Assessment & Taxation Form No. 2- 146 -67 Rev. 12 -00 Supersedes 2- 146 -67 Rev. 9 -94 NEBRASKA DEPARTMENT OF REVENUE —White Copy printed with soy ink on recycled paper Authorized by Sections 76 -214, 77 -1327, R.R.S. 1943 COUNTY ASSESSOR— Canary and Pink Copies GRANTEE — Goldenrod Copy VvM 1. AAA (,.'ryT ' � t�y/•���il / { s��- -, �w ,I_.�{ C � � I� HINGTS./L}IYT C , ST1 �M �..r3 A EBI_ ffAS _ '�}, {. /A BOOK- =`I _ PAGE" (S) �`E(° _4 ry 0— EEGISTER OF REELS .#, '4e 1 IOA P _11 AX I LI PAXI F H. IFH '1 � 2008 JUN 18 AM 11; WASI-4HNG T vi'v 0OUNTV REGES'I 'ER OF DEEDS THAT Judith E. Watanabe and Mike M. Watanabe, wife -and husband, Grantor, in consideration of one dollar ($1.00) and other valuable consideration received from the City of Blair, Washington County, State of Nebraska, Grantee, do hereby grant, bargain, sell, convey and confirm unto Grantee the following described real property: Grave spaces 3, 4, 5, and 6 in Lot No. 12, Block 42 of the Blair Cemetery located in the Northeast Quarter of the Northeast Quarter (NEI /4 NEI /a) of Section Twelve (12), Township Eighteen (18) North, Range Eleven (11) East of the 6 P.M., Washington County, Nebraska. To have and to hold the above described premises together with all tenements, hereditaments and appurtenances thereto belonging unto the Grantee and to Grantee's heirs and assigns forever. And the Grantor does hereby covenant with the Grantee and with Grantee's heirs and assigns that Grantor is lawfully seised of said premises; that it is free from all encumbrances; that Grantor has good right and lawful authority to convey the same; and that Grantor warrants and will defend the title to said premises against the lawful claims of all persons whomsoever. DATED this day of , 2008. - .i W Luaxu STATE OF NEBRASKA ) ) ss. COUNTY OF r >t� Recorded < <_� •: ' General Numerical Photostat s Proofed ! anned _. T'f'1 T T 11' ��' -? 11'E11�✓ 1U11Le::L The foregoing instrument was acknowledged before me on the I i rte day of J , , 2008, by Judith E. Watanabe and Mike M. Watanabe, wife and husband. ( 1 Notary Public ' NO After recording, please return to: Rq; GENERAL TAR -State of Nebraska ADAM �l. apMQUI5T Rachel A. Truhlsen, Attorney � ', MY Comm, L Aug. 1, 2011 P.O. Box 70 Blair, Nebraska 68008 -0070 5808 Briggs Street Omaha, NE 68106 June 23, 2008 Mr. Pat Long Cemetery Superintendent City of Blair 218 S. 10 Street Blair, NE 68008 Dear Mr. Long: Attached are the copies of a Warranty Deed and Real Estate Transfer Statement, which were mailed to Brenda Wheeler on June 19, 2008. These are for sale of grave spaces 3, 4, 5, & 6 in Lot 12, Block 42 of the Blair Cemetery. The Warranty Deed was recorded on June 18. As previously discussed, we are to receive $200 per grave space or a total of $800 for this sale. If you have any questions, please contact me at 402 -558 -1077 or Kathy, Blair City Hall, 426 -4191. Thank you. Sincerely yours, Judith E. Watanabe TO 8E FILED Real Estate Transfer Statement FORM 'uVTFH REGISTER e Read instructions on reverse side 521 OF DEEDS THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1-25 ARE ACCURATELY COMPLETED I County Name 2 County Number 3 Date of Sale 4 Date of Deed ;aE b J 1'1,V tor, $ ;B�� Mo. Day . Yr. Mo. ___1_1Day Yr. Is Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print) Grantor's. Name (Seller) Grantee's Name (Buyer) and 74 k 1302-a—_1 r Street or Other Mailing Address Street or Other Mailing Address IS 0 8 B r- J. S t 25 F' Print or Type Name of Grantee or Authorized Representative 2 .ry 3 1 85 -S � 1 6 it h t City State Zip Code city State Zip Code Date 6 F5 1 5 FOR NDR USE ONL� Telephone Number 27 Value of Stamp or Exempt Number Telephone Number 4 10 5' 1 5 f 1 0 7 7 30 4 0,'9 4 2 6 — A 19 1 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home. (A) Status (B) Property Type (C) (1❑ Improved - (1)❑ Single Family (4) [:] Industrial (6)E] Recreational (8) ❑ mineral Interests- (9) [:] state Assessed r(l) ❑ Mobile Home (2)❑ Unimproved ](3)[] (2)❑ Multi-Family (S) ❑ Agricultural (7) ❑ Mineral Interests- Producing (10) E] Exempt E:l (3)❑ IOLL Commercial Nonproducing 8 Type of Deed F-1 warranty ❑ Sheriff ❑ Executor ❑ mineral MCcemetery ❑ Quit Claim ❑ conservator ❑ Partition ❑ Trust ❑ Other 10 Type of Transfer M Sale ❑ Auction F-1 Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ other (explain) 11 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 UNO ❑ Spouse F Parents and Child [:] Family Corporation or Partnership ❑ Grandparents and Grandchild ❑ Brothers and sisters ❑ Aunt or Uncle to Niece or Nephew ❑ other. 141f 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? $ 3 ;"r 0 ❑ YES 91 NO $ % Does this conveyance divide a current parcel of land? 17 F YES NO ❑YES EINO Was sale through a real estate agent! (it Yes, name Address of Property Name and Address of Person to B ir la 218 31 1-6th St. B.'J'air. NE 6•008 Tax oe sent 20 Legal Description Gavae 5pacas 3 4, 5. an-id 6 ix. Lot No. 12, '"Ploxvk 42 of the Blair Caniete-U loc,-ated ir, the 11ordlea-c-t QGtarter of the No Qpat- (INFI NE!') of Sectioii Tij� (12) , 1-oA-j E 1'18 North, 8q 8 Ise t t t , t. P . M. , if as h ...iag or. Con"n ty 14 eb r 21 If agricultural, list total number of acres 22 Total purchase price, including any liabilities assumed ............. ............................... 22 $ —0— 23 $ 23 Was nonreal property included in purchase? ❑ YES _fN NO (if Yes, enter amount and attach itemized list) 24 Adjusted purchase price paid for real estate (line 22 minus line 23) ........... ................. ...... 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 I am duly authorized to sign this statement. -A 42 25 F' Print or Type Name of Grantee or Authorized Representative Telephone Number sign j t ol -f-nev lo- 1 , AD jr IDS; h ere signature of Grantee or Authorized Representative Title Date REGISTER OF DEEDS' USE ONLY FOR NDR USE ONL� 26 Date Deed Recorded 27 Value of Stamp or Exempt Number 28 Deed Book 29 Deed Page 30 Mo. i Day "A Nebraska Department of Property Assessment Taxation Authorized by Sections 76-214, 77-1327, R.R.S. 1943 Form No. 2-146-67 Rev. 12-00 supersedes 2-146-67 Rev. 9-94 NEBRASKA DEPARTMENT OF REVENUE White Copy COUNTY ASSESSOR Canary and Pink Copies GRANTEE— Goldenrod Copy printed with soy Ink on recycled paper vsr $BTNGTON COUNT , STA1% OF P�lEE1?C��1�r 11'�'ii�} iJir ✓l. CJt ,� AT ilv d M, BOO � ,12 — PACE(S) 4 0- 4 REGISTER OF DEEDS W 1 P E r � .17r _.� A NA, ����,_.,_. .._,.. h D �i��LPPEN lb"tR G safe ,,2- — 2000 JUN 18 AM 11: 35 KARP�! A iVIADSEN WASHINGTON 0OUNTY REGi51• ►. R OF DEEDS 8 -Al A. N1v THAT Judith E. Watanabe and Mike M. Watanabe, wife-and husband, Grantor, in consideration of one dollar ($1.00) and other valuable consideration received from the City of Blair, Washington County, State of Nebraska, Grantee, do hereby grant, bargain, sell, convey and confirm unto Grantee the following described real property: Grave spaces 3, 4, 5, and 6 in Lot No. 12, Block 42 of the Blair Cemetery located in the Northeast Quarter of the Northeast Quarter (NE' /a NEl /4) of Section Twelve (12), Township Eighteen (18) North, Range Eleven (11) East of the 6 P.M., Washington County, Nebraska. To have and to hold the above described premises together with all tenements, hereditaments and appurtenances thereto belonging unto the Grantee and to Grantee's heirs and assigns forever. And the Grantor does hereby covenant with the Grantee and with Grantee's heirs and assigns that Grantor is lawfully seised of said premises; that it is free from all encumbrances; that Grantor has good right and lawful authority to convey the same; and that Grantor warrants and will defend the title to said premises against the lawful claims of all persons whomsoever. DATED thi day of _., , 2008. T,,d F Wa tanabe L�.a�a uia E . STATE OF NEBRASKA ) ) ss. COUNTY OF „tGeL; The foregoing instrument was acknowledged before me on the ! i 7 day of ;�;�_ , 2008, by Judith E. Watanabe and Mike M. Watanabe, wife and husband. - / Notary Public — ; GENERAL Nt) ?AR1' -State of Nebraska After recording, please return to: ADAM EtL00MQUlST Rachel A. Truhlsen, Attorney � '.. My Comm, Exp. Aug. 1, 2011 P.O. Box 70 Blair, Nebraska 68008 -0070 Recorded General NomerecW Photostat Proofed �i at�ried Mike T '., 1V Sll�l. 1�J .. 'YY Tl ULU11Gt: STATE OF NEBRASKA ) ) ss. COUNTY OF „tGeL; The foregoing instrument was acknowledged before me on the ! i 7 day of ;�;�_ , 2008, by Judith E. Watanabe and Mike M. Watanabe, wife and husband. - / Notary Public — ; GENERAL Nt) ?AR1' -State of Nebraska After recording, please return to: ADAM EtL00MQUlST Rachel A. Truhlsen, Attorney � '.. My Comm, Exp. Aug. 1, 2011 P.O. Box 70 Blair, Nebraska 68008 -0070 525 F Ili 2000 AL 31 PM 12: 4 1 QUITCLAIM DEED KAREJ /=- [v'1,4,,D3EN WA5Hfl' COUNTY REGISTE OF DEEDS BLAIR NF Clarence and/or Marilyn Mueller, GRANTOR, in consideration of One Dollar and other good and valuable consideration received from City of Blair, Nebraska, GRANTEES; Clarence and/or Marilyn Mueller, quitclaims to GRANTEES, City of Blair, Nebraska, the following described real estate, (as defined in Neb. Rev. Stat. 76 - 201): Grave Space(s) 4 Lot No. 2 in Block No. 118, of the Blair Cemetery, in the City of Blair, Nebraska. Executed: ZZ ' ZZ , 2008. State of Nebraska ) ss County of Dodge Marilyn Mueller, Grantor The foregoing Quitclaim Deed was acknowledged before me on they -W) day of ZzzzzC— 2008, by Marilyn Mueller, Grantor. ----------- - -- IVU: GEN ERAL NOTARY - state of Ne Lj EIEIAI N O'EI25 . 2010 N / PEG13Y sEAMAN M C Exp, April 25,2010 Recorded NEBRASKA DOCUMENTARY I < D $ -� C )0Yd30?1 WASfUNGTON COUNTY, STATE OF NEBRASKA RECORDED 42ZIt14-4-2— ATI! 4qM. BOOK 529 PAGE(S) —5 54 � General Numerical Photostat Proofed Scanned J �aA&vv CL- 4 REGISTER OF DEEDS * *DUPLICATE ** This is to certify that Mueller, Clarence and /or Marilyn has this day purchased of the CITY OF BLAIR, Washington County, and State of Nebraska, the following piece of land, situated in the Northeast Quarter of the Northeast Quarter of Section Twelve, Township Eighteen North, Range Eleven East and more particularly described as follows, to wit: Grave Space(s) 4 Lot No. 2 in Block No. 118 of the BLAIR CEMETERY, and that the said CITY OF BLAIR, NEBRASKA is the owner of the above described premises as laid down on the plat on file in the office of the Clerk of said City, to have and to hold unto the said Mueller, Clarence and /or Marilyn heirs and assigns, the above described premises in fee simple for the purpose of interment, under the regulation of the Council of said City, subject also to all rules and regulations adopted from time to time by the CITY OF BLAIR, NEBRASKA. In witness Whereof, the said grantor path set its Seal and caused these presents to be signed by its Mayor and countersigned by its Clerk, at Blair this 27th day of May, A. ®. 1999. Price of Lot $ 250.00. i , 4' (Seal) , ' � V 1 11 �. 1. 1 County Name 2 County Number 27 Value of Stamp or Exempt Number $ 3 Date of Sale 4 Date of Deed 30 Mo. Day Yr. Mo. Day Y,­. __LL Is Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print) Grantor's Name (Seller) Grantee's Name (Buyer) Street or Other Mailing Address Street or Other Mailing Address City State Zip Code city State Zip Code Telephone Number Telephone Number 7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories A and B. Check C also if property is mobile home. (A) Status (B) Property Type (C) (1)❑ Improved (1) [:] Single Family (4) ❑ Industrial (6) [:] Recreational (8) [-] Mineral Interests- (9) F State Assessed (1) ❑ Mobile Home (2)❑ Unimproved ❑ (2)F] Multi-Family (5) [:1 Agricultural (7) E:1 Mineral Interests- Producing (10) ❑ Exempt (3)❑ IOLL (3)❑ Commercial Nonproducing 8 Type of Deed El ❑ Warranty El Sheriff E] Executor El Mineral cemetery Claim ❑Conservator ❑ ❑ Partition ❑ Trust El Other_ Quit 10 Type of Transfer El Sale - 1 Auction ❑ Gift ❑ Exchange Ej Foreclosure ❑ satisfaction of Contract El Life Estate ❑Other (explain) 141f the real estate was transferred for nominal consideration, what is the current market Was mortgage assumed? If Yes, state amount and interest rate. value? (, 15 1:1 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) F YES F NO I [:I YES ❑ NO 18 Address of Property 19 Name and Address of Person to Whom Tax Statement Should be Sent 20 Legal Description e j 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) ................................... 1A Le�� I 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 I am duly authorized to sign this statement. 25 F Print or Type Name of Grantee or Authorized Representative Telephone Number sign h ere F' Signature of Grantee or Authorized Representative Title Date I REGISTER OF DEEDS' USE ONLY FOR NOR USE ONL 26 Date Deed Recorded Mo. — Day —Yr 27 Value of Stamp or Exempt Number $ 28 Deed Book 129 Deed Page 30 Nebraska Department of Property Assessment & Taxation Form No. 2-146-67 Rev. 12-00 Supersedes 2-146-67 Rev, 9-94 NEBRASKA DEPARTMENT OF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies printed with s oy ,,k on recycledMpe, Authorized by Sections 76-214, 77-1327, R.R.S. 1943 GRANTEE — Goldenrod Copy ❑ YES ❑ NO ❑ spouse ❑ Parents and Child ❑ Family Corporation or Partnership ❑ Grandparents and Grandchild ❑ Brothers and Sisters ❑ Aunt or uncle to Niece or Nephew ❑ Other Clarence and /or Marilyn Mueller, GRANTOR, in consideration of One Dollar and other good and valuable consideration received from City of Blair, Nebraska, GRANTEES; Clarence and /or Marilyn Mueller, quitclaims to GRANTEES, City of Blair, Nebraska, the following described real estate, (as defined in Neb. Rev. Stat. 76 -201): Grave Space(s) 4 Lot No. 2 in Block No. 118, of the Blair Cemetery, in the City of Blair, Nebraska. Executed: , 2 , 2008. State of Nebraska ) ) ss County of Dodge ) Marilyn Mueller, Grantor ` The foregoing Quitclaim Deed was acknowlec SC — , 2008, by Marilyn Mueller, Grantor. before me on the —�'4�� day of GENERAL. NOT • State of Nebraska pEGGY SEAMAN Notary My Comm. UP. April 25, 2010 * *DUPLICATE ** This is to certify that Mueller, Clarence and /or Marilyn has this day purchased of the CITY OF BLAIR, Washington County, and State of Nebraska, the following piece of land, situated in the Northeast Quarter of the Northeast Quarter of Section Twelve, Township Eighteen North, Range Eleven East and more particularly described as follows, to wit: Grave Space(s) 4 Lot No. 2 in Block No. 118 of the BLAIR CEMETERY, and that the said CITY OF BLAIR, NEBRASKA is the owner of the above described premises as laid down on the plat on file in the office of the Clerk of said City, to have and to hold unto the said Mueller, Clarence and /or Marilyn heirs and assigns, the above described premises in fee simple for the purpose of interment, under the regulation of the Council of said City, subject also to all rules and regulations adopted from time to time by the CITY OF BLAIR, NEBRASKA. In witness Whereof, the said grantor hath set its Seal and caused these presents to be signed by its Mayor and countersigned by its Clerk, at Blair this 27th day of May, A.D. 1999. Price of Lot $ 250.00. (Seal) r. vnn- 4 -1 63 4y NEBRASKA DOCUMENTARY STATE OF NEBRASKA COUNTY OF WASHINGTON)ss ST AMP f4M TAX rENTFRFO IN N(MERICAL IN EX AND FILED FOR RECORD E���� a . � 15 ,°zv0Lf r THIS / -- OAY OF . A.O. &2� d y v� AT . O' 'C OCK ? AND RECORDED IN BOOK _ 46 AT RAOF COUNTY CLGRK DEPUTY 3 CEMETERY QUITCLAIN4 DEED E I fR t Richard Hineline and Joan Hineline, husband and wife, GRANTORS, in consideration of One Dollar ($1.00) and other valuable consideration, quitclaims to the City of Blair, Washington County, Nebraska, GRANTEE, in the following described real estate (as defined in Neb. Rev. Stat. 76 -201) in Washington County, Nebraska: Grave Space(s) 5, 6 Lot 17 in Block No. 107, of the Blair Cemetery, City of Blair, Washington County, Nebraska Executed: June ` , 2004 r -t. Richard Hineline I Jo 1ineline 1 TO BE FILED R ea l E s t a t e T rans f er St a t emen t FORM WITH REGISTER ® Read instructions on reverse side OF DEEDS THE DEED WILL NOT BE RECORDED UNLESS THIS STATEMENT IS SIGNED AND LINES 1 -25 ARE ACCURATELY COMPLETED 1 County Name 2 County Number 3 Date of Sale 4 Date of Deed Mo. Day Yr. Mo. Day Yr. 5 Grantor's Name, Address, and Telephone (Please Print) 6 Grantee's Name, Address, and Telephone (Please Print) Grantor's Name (Seller) Grantee's Name (Buyer) Street or Other Mailing Address Street or Other Mailing Address City State Zip Code City State Zip Code Telephone Number Telephone Number 7 PROPERTY CLASSIFICATION NUMBER. Check one box in categories ,4 and B. Check C also if property is mobile home. (A) Status (6) Property Type I (C) (1)" Improved (1)Lj Single Family (4) LJ Industrial (6) LJ Recreational (8) Lf Mineral Interests- (9) Lj State Assessed (1) L] Mobile Home (2)❑ Unimproved (2)❑ Multi - Family 1 (3)[:] (5) ❑ Agricultural (7) ❑ Mineral Interests- Producing (10) ❑ Exempt (3)❑ IOLL Commercial Nonproducing R Type of Deed 9 ❑ Warranty ❑ Sheriff ❑ Executor ❑ Mineral ❑ Cemetery ❑ Quit Claim ❑ Conservator ❑ Partition ❑ Trust ❑ Other 10 Type of Transfer El Sale ❑ Auction ❑ Gift ❑ Exchange ❑ Foreclosure ❑ Satisfaction of Contract ❑ Life Estate ❑ Oth (e xpl ai n) 1]. Ownership I ransterred in FUII (if No, explain division) 1L Was real estate purchased for same use? (if No, state intended use) ❑ YES ❑ NO ❑ YES ❑ NO 13 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. 141f 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 Address of Property 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 .............. ............................... 22 $ 23 Was nonreal property included in purchase? ❑ YES ❑ NO (if Yes, enter amount and attach itemized list) .. 23 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 I am duly authorized to sign this statement. 25 Print or Type Name of Grantee or Authorized Representative Telephone Number sign h ere Signature of Grantee or Authorized Representative Title Date ' REGISTER OF DEEDS' USE ONLY FOR NDR USE ONL 26 Date Deed Recorded 27 Value of Stamp or Exempt Number 28 Deed Book 23 Deed Page 30 Mo. Day Yr. Nebraska Department of Property Assessment & Taxation Authorized by Sections 76 -214, 77 -1327, R.R.S. 1943 Form No. 2- 146 -67 Rev. 12 -00 Supersedes 2- 146 -67 Rev. 9 -94 47�,. NEBRASKA DEPARTMENT OF REVENUE — White Copy COUNTY ASSESSOR — Canary and Pink Copies GRANTEE — Goldenrod Copy Q , P printed with soy ink on recycled paper