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Statement to Tax jig Officials <br />GrwW T-1-nd Nebr. <br />87- 101238 <br />11 <br />Form P-IM This Statanimt is ConfMentW and Available <br />(Beviled) to nXing Ofaclab 01dy <br />This form, Pursuant to Section 76-214 R. R. S. 1943, as amended by the 75th Session of the Nebraska <br />Legislature, must be completed by every Grantee and filed at the time each deed of real estate is Pre- <br />sented for recording. <br />Donald W-. Haggart Vernon Ray Bauer <br />L Grntr –eyC <br />--D& oratby-1-- Bauer --- <br />Address_GEap4 I slamd. Nebraska. <br />Nebraska <br />Type of bust vrnent-_WLarrants Deed Date okwtr���7 <br />The Northwest Quarter (NW) of Section Thirty Three (33), Township fl <br />IL Legal Description Twelve (12) north, Range Nine (a) west of the 6th P.M., Hall Cam <br />'br, ka ty <br />Ne ;Deed is at 9.0rtiou conveyed to the State of Nebraska by Warranty <br />', excepting therefrom that tj <br />dated April 26, 1937 and recorded in the Office of Re�gister of,Deeds, Hall County, <br />Nebraska, in Deeds book #77 at page #92, and also excepting therefrom that portion deeded! 11 <br />to Donald W. Haggart and Evelyn C. Haggart, said deed dated September 8, 1967 and record- - <br />€1 H �ed in the Office of the Reg--;ster of Deeds, Hall County Nebraska, in Deeds book #154 at <br />I . <br />pa%LI5&1 <br />ksiderati,, <br />A. Total Consideration paid (cash, mortgages, property traded, <br />assumed liabilities, etc.) $20,000-00 <br />R Personal Property Included in Purchase <br />C. Leases and Easements Included in Purchase <br />D. Other Items Included in Purchase $ <br />K If Contract Sale, Total Interest & Carrying Charges <br />$ <br />TV. Check Applicable Staternent <br />Sale or Transfer Between Relatives. <br />Sale of Property in Connection with Foreclosure, Bankruptcy, <br />Condemnation or Other Such Legal Action. <br />if Purchase for different use than by Previous Owner <br />(For Example—Agricultural to Industrial Use) <br />FxJ Other, Explain: <br />A <br />L the undersigned, having personal knowledge of this t–ransactim oerufy that the, foregunig is <br />4 true and correct <br />Z, <br />­--) <br />Signature -Z2_ �Z� -L'Z- <br />Capacity — Broker <br />CERTIFICATION <br />OFFICIAL USE: <br />Book--.-- Page <br />Property Type: SU, UU, SS, MS, 1, C, <br />If Agricultural: Total Acres---- irngated Acres____ <br />Type of Irrigation—­­- <br />Assessed Values <br />Land <br />Improvements $ TOTAL S. <br />This Sale should be used in a Sa)ps Asw"ment Ratio Yes C] No Ll <br />I Explain "No" answer on reverse side) <br />County- <br />County Identification <br />