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Form No. 108 ISBA* 03760 <br />James R. Monroe, Es <br />dress Tax Statement <br />fTA>� <br />a* <br />o <br />L o= <br />ion rf <br />FOR THE LEGAL EFFECT OF THE USE OF <br />THIS FORM, CON$Uj j YOUR LAWYER <br />C <br />NEBRASKA DOCUMENTARY <br />STAMP TAX <br />D <br />2-dr 2 <br />$ <br />By <br />James R. Monroe, Es <br />dress Tax Statement <br />fTA>� <br />a* <br />o <br />L o= <br />ion rf <br />FOR THE LEGAL EFFECT OF THE USE OF <br />THIS FORM, CON$Uj j YOUR LAWYER <br />C <br />_ 1 —4 <br />n z <br />D p <br />— <br />R7 N V) <br />1 S <br />^ o <br />N -n <br />n =3 r <br />N N <br />t+ 7c <br />v <br />Cn <br />O <br />N <br />(P.O. Sox 41355, Des Moines, IA 50311/(515)244 -0652) <br />11 G <br />CORRECTED <br />rson, 4200 Beaver Hills Drive, - SPACE ABOVE THIS LINE <br />Des Moines, IA 50 310RECORDER <br />QUIT CLAIM DEED <br />For the consideration of One ($1.00 _ <br />Dollar(s) and other valuable consideration, <br />CARROLL G. ANDERSON and EILEEN M. ANDERSON, as husband and wife <br />do hereby Quit Claim to <br />CARROLL G. ANDERSON, as Trustee of the CARROLL G. ANDERSON FAMILY TRUST, to be held <br />by the Trustee and administered according to the terms of the Carroll G. Anderson <br />Revocable Trust Agreement dated November 26, 1999, as it may be amended <br />all our right, title, interest, estate, claim and demand in the following described real estate in <br />Hall County, IBS6dt'e[ Nebraska; <br />(see attached EXHIBIT A) <br />Consideration less than $500.00; exempt transaction. <br />Each of the undersigned hereby relinquishes all rights of dower, homestead and distributive share in <br />and to the real estate. <br />Words and phrases herein, including acknowledgment eof, ;shall be construed as in the singular or <br />plural number, and as masculine or feminine gender, acco Ping toitha context. <br />Dated: WMymbWr 3 200IL— / <br />CARROLL G. AN ERSON (Grantor) <br />STATE OF IOWA ss: may, <br />PoL P.X' COUNT,,Yht�,,. ,r,C�..J /�( G� <br />On this day of Ncryemb (dtOv"Y)EILEEN M. ANDERSON (Grantor) <br />20 04/ , before me, the undersigned, a Notary <br />Public in and for said State, personally appeared <br />CARROLL G. ANDERSON and EILEEN M. (Grantor) <br />ANDERSON, as husband and wife <br />to me known to be the identical persons named in <br />and who executed the foregoing instrument and <br />acknowledged that they executed the same as their <br />voluntary act and de_ ed. <br />(This form of <br />COMMISSION # 111859 <br />MY COMMISSION EXPIRES <br />® TM law& <br />(Grantor) <br />(Grantor) <br />(Grantor) <br />(Grantor) <br />106 QUIT CLAIM DEED <br />� I1ry1. <br />Ay03 I <br />C <br />O. <br />V�9 <br />COD <br />It <br />