DM-2015-00760.tif 1
WASHINGTON COUNTY TREASURER
P.O. BOX 348 BLAIR, NEBRASKA 68008
PHONE (402)426.6888
FAX (402)426 -6880
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MARJORIE S. HOIER MERRI F. HIGHTREE
COUNTY TREASURER DEPUTY COUNTY TREASURER
AUGUST 31, 2015
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TO WHOM IT MAY CONCERN:
THE 2015 REAL ESTATE TAXES HAVE BEEN PAID IN FULL ON THE
BUILDING ONLY LOCATED ON
PARCEL NUMBER: �
WAS N TON COUNTY TREASUR
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Date Created WASHINGTON COUNTY TREASURER'S OFFICE Last Update
11/17/2014 TAX STATEMENT FILE 08/21/2015
Statement:2014- 890041405RP Land Value: 47,065 Roll Year 2014/2014
Parcel # 890041405 GB Loss 0 Source REAL
Mortgage #: Imp Value 1,095,370 Gross Tax 22,857.70
Owners ID: 16757 Outbldgs 0 Greenbelt 0.00
District 208 Tot Value 1,142,435 Homestead 0.00
Tax Rate 2.000788 HS Amount 0 Tax Credit 817.30
UU Tax Cr: 0.00 Taxable 1,142,435 Taxes Due 22,040.40
Drainage 0.00
KELLY RYAN EQUIPMENT CO Delinquent Penalty Tax: 0.00
900 KELLY RYAN DR Year: 0 Cert Fees 0.00
PO BOX 488 Advertising: 0.00
BLAIR, NE 68008 -0000 Total Due 22,040.40
Map # B18- 12- 7 -TL - 55 Tax Paid 22,040.40
Legal BC TL 55 7 -18 -12 114 PC 46 Tax Due 0.00
Situs 900 KELLY RYAN DR BLA Int Due 0.00
Notes Total Due 0.00
Page 1 of 3
890041405 2014 / 2014 KELLY RYAN EQUIPMENT CO 2
Mortgage Information 0
Loan Number Tax Sale # /Date
Delinquent Report
Bankruptcy #
Foreclosure Date
Resolution Date
PA &T Class Codes 01 04 04 01 04 00
Tax Sale Certificate Data
Certificate # Filing Fees
Purchasers ID # Interest Due
Date Purchased Total Amount
Certificate Type Redemption Date
Maturity Date Redemption #
Principle Redemption Amount
Page 2 of 3
Tax Payment Interest Drainage Total Pay PAID BY
11,020.20 0.00 11,020.20 KELLY RYAN EQUIPMENT CO
11,020.20 0.00 11,020.20 KELLY RYAN EQUIPMENT CO
890041405 2014 / 2014 KELLY RYAN EQUIPMENT CO
TIF Fund # Tax Credit Rate 0.0007154 0.00
Gross Taxes Taxes after HS Tax Credit Net Taxes
Base 0 22,857.70 22,857.70 817.30 22,040.40
Excess 0.00 0.00 0.00 0.00
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Change Date Change Code Prev Value New Value Value Change Tax Change
890041405 REAL Page 3 of 3
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SID PRINCIPAL Interest Due PENALTY Ad Due Total Due S
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Total 0.00 Statmnt Date /Seq #11/17/2014 5303 0.00 j
KEL48220
n COM. CO POL ICY CHA DATE (MMID
f{l� fT 08/28 15 l
PRODUCER PHORE
AIC No Exc : 402 861 X PROPERTY GENERAL LIABILITY
The harry A. Koch Co. PTYPE INLAND MARINE AUTO/TRUCKERS
P.O. Box 45279 UMBRELLA WORKERS COMP
Omaha, NE 68145-0279 COMPANY NAIC CODE:
CODE: suB CODE: Sentry Insurance
CUSTOMER 10: 172 6 5 ATTENTION:
INSURED'S NAME POLICY NUMBER EFFECTIVE DATE OF CHANGE
Kelly Ryan Equipment Co. 904363106 08/28/15
INSURED'S MAILING ADDRESS IF CHANGED (INC ZIP +4) POLICY INCEPTION DATE POLICY EXPIRATION DATE
P O Box 488 12/01/14 12/01/15
Blair, NE 68008
THIS IS AN ACKNOWLEDGEMENT OF YOUR REQUEST. UPON APPROVAL, THE COMPANY'S RECORDS WILL
BE ADJUSTED ACCORDINGLY, AND IF A PREMIUM ADJUSTMENT IS REQU [RED, IT WILL BE DONE AT
PREMIUM AUDIT OR BY ENDORSEMENT.
PREMISES INFORMATION ADD CHANGE DELETE
LOC # BLD # STREET, CITY, COUNTY, STATE, ZIP+4 CITY LIMITS INTEREST YR BUILT PART OCCUPIED
900 Kelly Ryan Drive, BlaiT Blair-,NE INSIDE OWNER
1 2 68008 OUTSIDE TENANT
NATURE OF BUSINESSIDESCRIPTION OF OPERATIONS BY PREMISE(S) ADD CHANGE X DELETE
LOC # BLD #
1 2 Main Office
AUTO - VEHICLE DESCRIPTION /LIMITS POLICYLIMIT(S) CHANGED ' ADD CHANGE DELETE
VEH # I YEAR MAKE: BODY SYMIAGE COST NEW
PE'
MODEL: V.I.N.: $
CITY, STATE, TERR GVWJGCW CLASS SIC FACTOR SEAT CP RADIUS FARTHESTTERM
ZIP WHERE
GARAGED
DRIVE TOWORKISCHOOL USE CHECK UNDRINS DEDUCTIBLES SPEC
COMM'L COVERAGES NO NO FAULT MOTOR F LSP ACV COMP C OF L
UNDER 15 MILES PLEASURE RETAIL LIAB MED PAY TOWING NO UNINS SPEC
& LABOR FT COMP AA ST AMT $
15 MILES OR OVER FARM SERVICE FAULT MOTOR. C OF L FTW COLL $ $ COLL
LIABILITY NO FAULT ADD'L NO FAULT MEDICAL PAYMENTS UNINSURED MOTORISTS I UNDERINSURED MOTORISTS
S
I $ I $ I
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AUTO - VEHICLE DESCRIPTION /LIMITS POLICY LIMIT($) CHANGED ADD CHANGE I DELETE
VEH # I YEAR MAKE: BODEY, SYM /AGE COST NEW j
MODEL: I V.I.N.: $
CITY STATE, TERR GVW /GCW CLASS sic FACTOR SEATCP RADIUS FARTHESTTERM
ZIP >fv1-IERE
GARAGED
DRIVE TO WORK/SCHOOL USE COMM'L CHECK ADD'L UNDRINS F LSP DEDUCTIBLES ACV COMP SPEC
CO ERAGES NO FAULT MOTOR COF L
UNDER 15 MILES PLEASURE RETAIL LIAR MED PAY TOWING FT COMP AA ST AMT $
& LABOR
NO UNINS SPEC
15 MILES OR OVER FARM SERVICE FAULT MOTOR C OF L FTW COLL $ $ COLL
LIABILITY I NO FAULT ADD'L NO FAULT MEDICAL PAYMENTS UNINSURED MOTORISTS I UNDERINSURED MOTORISTS
I s Is Is I $ I
DRIVER INFORMATION List drivers who frequently use own vehicles ADD I I CHANGE I DELETE
DRIVER NAME (Include address, If required) DATE OF BIRTH YEAR DRIVERS LICENSE NUMBER/ STATE USE
DRIVER INFORMATION List drivers who frequently use own vehicles ADD I CHANGE DELETE
DRIVER NAME Include address, if required) DATE OF BIRTH YEAR DRIVERS LICENSE NUMBER/ STATE USE
SOCIAL WORKERS COMPENSATION RATING INFORMATION
TYPE OF COM- *OF ESTIMATED
CHANGE STATE LOC CLASS CODE PANY CATEGORIES, DUTIES, CLASSIFICATIONS EM- ANNUAL
USE PLOYEES REMUNERATION
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ACORD 175 (7196) 1 of 4 #6 5730 HAUGLA ACORD CORPORATION 1991
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PROPERTY /INLAND MARINE - PREMISES INFORMATION PREMISE S #:1 BUILDING #: 2 F ADD FI CHANGE a DELETE
SUBJECT OF INSURANCE AMOUNT COINS % VALUATION CAUSES OF LOSS F ATIO
GUARD DEDUCTIBLE FORMS AND CONDITIONS TO APPLY
Building See
Remarks
(See attached Subject of Insurance page)
ADDITIONAL COVERAGES, OPTIONS, RESTRICTIONS, ENDORSEMENTS AND RATING INFORMATION
CONSTRUCTION TYPE FIRE DISTRICT /CODE NUMBER PROT CL # STORIES # BASWTS YR BUILT TOTAL AREA
BUILDING IMPROVEMENTS PLUMBING, YR: OTHER OCCUPANCIES
WIRING, YR: HEATING, YR:
ROOFING, YR: OTHER:
RIGHT EXPOSURE & DISTANCE LEFT EXPOSURE & DISTANCE ' REAR EXPOSURE & DISTANCE
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BURGLAR ALARM TYPE CERTIFICATE # EXPIRATION DATE EXTENT GRADE CENTRAL STATION
WITH KEYS
BURGLAR ALARM INSTALLED AND SERVICED BY #GUARDSfWATCHMEN CLOCK HOURLY
PREMISES FIRE PROTECTION (Sprinklers, Standpipes, CO /Chemical Systems) FIRE ALARM MANUFACTURER CENTRAL STATION
LOCAL GONG j
INLAND MARINE - SCHEDULED EQUIPMENT %COINSURANCE: I ADD CHANGE I DELETE
# MODEL DESCRIPTION AMOUNT OF
YEAR (TYPE, MANUFACTURER, MODEL, CAPACITY, ETC) ID #!SERIAL # DATE AMU
PURCHASED NEW /USED
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$ i
GENERAL LIABILITY - LIMITS I I CHANGE
GENERAL AGGREGATE $ EACH OCCURRENCE $
PRODUCTS & COMPLETED OPERATIONS AGGREGATE $ FIRE DAMAGE (Anyone fire) $
PERSONAL & ADVERTISING INJURY $ MEDICAL EXPENSE (Any one person) $
GENERAL LIABILITY - SCHEDULE OF HAZARDS
PE OF LOCATION CLASSIFICATION CLASS PREMIUM
CHANGE CODE BASIS
TERR PREMIUM BASIS CODES
#
(S) GROSS SALES - PER $1,000 /SALES
(P)PAYROLL -PER $1,000/PAY
(A)AREA -PER 1,000 /SO FT
(C)TOTAL COST -PER $1,000 /COST
(M)ADMISSIONS -PER 1,000 /ADM
(U)UNIT -PER UNIT
(T) OTHER
UMBRELLA I I CHANGE
LIMIT OF LIABILITY $ OTHER
RETAINED LIMIT $ (DESCRIBE)
ADDITIONAL INTEREST I I ADD I I CHANGE I DELETE
INTEREST I RANK: NAME AND ADDRESS REFERENCE #: CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED PREMISES: BUILDING:
LOSS PAYEE VEHICLE: BOAT:
MORTGAGEE ( # -) SCHEDULED ITEM NUMBER:
MORTGAGEE ( #_) OTHER
LIENHOLDER
EMPLOYEE AS LESSOR I ITEM DESCRIPTION:
ADDITIONAL CHANGES /REMARKS
Change Description: Delete bldg 2 at loc 1 - 900 Kelly Ryan Dr
(See attached Additional Changes /Remarks page)
SIGNATURE (Any deletion or reduction in coverage requires the Insured's signature
INSURED's PRODUCER'S /�, j
SIGNATURE SIGNATURE `^""-" C�l
ACORD 175 (7/96) 2 of 4 #6S730
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SUBJECT OF INSURANCE Continued from Page 2
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( g ) �
PREMISES #:] BUILDING #:2 ADD CHANGE X DELETE
SUBJECT OF INSURANCE AMOUNT COINS % VALUATION CAUSES OF LOSS INFLATION
GUARD DEDUCTIBLE FORMS AND CONDITIONS TO APPLY
Personal Property See
Remarks
Business Income & See
Extra Expense - Remarks
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AM S 175.9 (07/96) 3 of #65730
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ADDITIONAL CHANGES /REMARKS (Continued from Page 2)
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CHANGED: - NEW TOTAL BLANKET LIMIT
Blanket #: 1 Building
To: 6,002,000
CHANGED: - NEW TOTAL BLANKET LIMIT
Blanket #: 2 Personal Property
To: 4,553,500
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AM S 175.13 (07/96) 4 of4 #65730
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