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<br />Rsal Estate Transfer Statement ~ FDRM <br />To e$ ~IL.ED THiS STATEMENT IS CONFlDENTdAL -FOR TAX OFFICIALS ONLY C21 <br />`NtTH.REGISTER RBed'InStruttlOns Orl rBVerSe, ~l <br />OE DEEDS, <br />i <br />^ t Grantee'! Name !r3uva ] 1'-ast, First, ana morale Imnat) COUNTY ASSESSOR'S USE ONLY f <br />~ . ~' '~' -~.- ]Cqunty Name aCOUnty NO, 95ate NO, '.I <br />_ I _ <br />2addrast (Number antl St: eat er Rural Routal <br />~' ,'.t ~ DO.NOT WRITE:IN TH75 SPACE y <br />1. ]City --~ _--- State -~-- ZiP Coda <br />.tip tl <br />6 Gran tor'S tJamb(Sell r) Gast, Flrst. -]np Middl eL ~ nlrlat) <br />~ !J i (` r f2 to Typeof Rea1Estate <br />i <br />ss address ENtxnbera tl5tr .t or Rura Route 1:~Sfngle.Family Resioanflal 5.~ Commercial: <br />t... ~ - 2^Multiple Family Resitlenllal 6..~j:Agrfoulturai.. <br />s i <br />~ City State Zip Code 3^.Vatant Residential Lott ]CDther. i <br />r .- 'i .> i.}t' , '. ,. - t 4Q lndustrlal <br />11 Typeof DNdIZ [Hta Of,Deep /3 Was th is a-sale between relatives? <br />~ } •` - i , 1 A . ; ^ 1> . ;~) ~,.,.j1';c ', I ') [l3-vES ~ ~':. A nNC <br />1 s LNas tea real astafa purcnasea-to - sane'use? 15 Was thi^a a forced sale? 76 it the rt at est. t v r nst tree <br />'.~ ~VES ,: ~ Nl~ YES ~~NO for rtomtnalr d t- .+nat ~, <br />7s the current +al ~e <br />t7 t~9elgastriOtlon. ~ ~ <br />l <br />' ,,'~ <br />f <br />i I. <br />',8 Total purchase price..... . ... . ... . ..........::....... . ....::. 18 .tee ~; ._ <br />19 Value of personal property, leases, and easements specifically includetl in purchase price (see instruction), 19. <br />'~ 20 Adjusted purchase pricepald forYeaiestate Iline 18 lessaine 1.9):.:.... Zp' <br />I _ ..... ................ ...:. i <br />Under Paaelties of perjury,aideplare~thar I have examined this°statemen4, and-chat rt istothe bestof my knowledge and belier, <br />true and correct, and that t am duly autharixed to srgathts statement <br />rl .~ <br />I HERE ~ signatur~:._ ^s..~ `ir • ~, Date lnf :jam x ' i <br />~~ . ~; REGISTER OF QEED'SUSE ONLY !'. <br />2t Date Dana Recorded 22. Value of Stamp Aiffxed 23 ROOD 2t.. Page ', <br />~ j. , <br />i <br />'COUNTY-ASSESSOR'S t1SE ONLY <br />u Srould tnls :ale be, usetl In e sa v~, assessment ri[tU s[uay' ) <br />i~vES l~Nu: rExplarn7 <br />Nebra.ka L>eUa•trr ante ..eve Jr Form No "~iafi-7Nr,. 9 r4 Autn grizaG by Section ]G :14 R. R:5. 194? <br />l^lhen completed by county assessor, mail. to: NEBRASKA DEPARTMENT OF REVENUE, BOX: 94818,L1NCDLM; NE 68509... <br />DtPA:tTW4: NT CUr. REVErviiE .'/;cite vgDY CO~rvT-r. A55ESSOH -. li!ec t,oNy ~I?nN''cc _er ,ry -;o;,y <br />..TbS Rev. t975 - Radttatd & eo,.,tnG., Omaha <br /> 25 Total ACras Or Lots 29TOtai irrigatetl A[ra5 27 Type oflrrlgation <br /> 2e Lantl `/aluatlon Grp Nutn bar DP Acres ~tnd VaiuatlDn Grp: NumberbP Apres Lantl Va!uatfgn Grp. N Uer c acres <br />LANG - ~-~- -' <br /> <br /> 29 Age 30 No_ cf Sto rle~ 31 No. 01 Rooms 32 NO. gPt3aths 3350udre Feat Flfea 345a>emcr; <br /> <br /> <br />IMPROVEMEN <br />S I <br /> <br />J <br />~'.^JO <br />~ <br />T 35 Fin'snea Rasemeat 3e ?yae or Heauna -- D arcel Numner <br />--- <br /> 3a Percent Funct Deal 39 Fertent ECOnOmIC 60 Nelgh nOrngg6 , <br />ASSESSED VALUE l et , a~a az trncrovements s3 TOidl ' <br />"~ <br />