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Statement to Taxing Officials <br />Lland, <br />87-101238 <br />jl Flom RM Mr. This Statment is Co" MUM and Avail" 1 <br />!i <br />'I I (Buviad) to Tardng ofBciais owy i k <br />This form, pursuant to Section 76-214 R. R. S. 1943, as amended by the 75th Session of the Nebraska t <br />! legislature, must be completed by every Grantee and filed at the time each deed of real estate is pre- 1 <br />seated for recording. t <br />f Donald W. Aaggart Vernon Pay Dauer <br />I. Grantor *ems -� _�agg_�*±• -- — Grantee Dorothy 7. Rauer <br />- <br />Addresr.-.--- Grand �—__.._Island —._Nebraska __.Address_ ;iargard, Nebraska <br />Type of Instrument_ �a- rranty Deed Date of ImKrument August 30, 1967 <br />' The Northwest Quarter (NWT) of Section Thirty Three (33), Township <br />II_ Legal Description Twelve (12) north, Range Nine (9) rest of the 6th P. M,, Ball Gouty, <br />;Nebraska, except therefrom that portion conveyed to the State of Nebraska by Warranty- <br />.,Deed <br />dated April 29, 1937 and recorded in the Office of Register of Deeds, Hall County, <br />Nebraska, in Deeds book #77 at page #92, and also excepting therefrom that portion deeded <br />to Donald W. Haggart and Evelyn C. Hagga --t, said deed dated September 8, 1967 and recorrd <br />ed in the Office of the Register of Deeds, Hamll County, Nebraska, in Deeds book #154 at <br />pa% f5Cbissideration <br />A. Total Consideration paid (cash, mortgages, property traded, <br />assumed liabilities, etc_) S 9C2,sXH1 Ot# <br />B. Personal Property Included in Purchase _ -- _ -- <br />C. Leases and Easements Included in Purchase <br />D_ Other items Included in Purchase <br />E. If Contract Sale, Total Interest & <br />Carrying Charges — <br />IV. Check Applicable Statement <br />}_ <br />' Sale or Transfer Between Relatives. <br />Sale of Property in Connection with Foreclosure, Banlaxirtcy, <br />Condemnation or Other Such Legal Action. <br />ElPurchase for different use than by Previous Owner <br />j� <br />(For Example — Agricultural to Industrial Use) <br />oOther, Explain: - Same, AZ:-3culttnra- - - -._-. -- -- M -- - -- <br />L the undersigned, having personal knowledge of this transaction, certify that the foregoing is <br />true and correct_ <br />Sigm !� yfF •- -/ ! d F <br />Capacity— _ y` aimz-- — <br />CERTIFICATION <br />OFFICIAL USE: <br />Property Type: SU, MU, SS, MS, I, C, A- - - -- <br />i <br />If Agricultural: Total Acres--- Irrigated Acres._ <br />Type of Irrigation - - -- --.. - - - -- - <br />Assessed Values <br />Book_ __._._ Page <br />Land �- . —. - - -- - - -- <br />Improvements $... _ _ -- _ _ -- _ _.._._ __- TOTAL This Sale should be used in a Sales Assessment Ratio Yes [J No F] <br />(Explain "No" answer on reverse side) <br />County_ _ <br />County Identification <br />