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<br />Certificate of Conveyance atl+er than Deeds of Real Estate ~ <br />This Statement is Confidential and Available <br />to Taxing dfficials Only <br />This form pursuant to Section 76-21~} R.R.S.. 143, as amended by the 7>th Session of the \ebraska <br />Legislature, must be completed and attached to every mortgage or other conveyance of real estate <br />except deeds of real estate before such instrument is filed for recording. <br />Parties to Instrument.....F~TRY ROF'e^ELD.A2tD,_tZLTBY.,fi0biFPILD <br />Type of Instrument „REAL..PROP~'RTY• r'ORTGAG~ ... Book ............ Page ............... <br />........ Date .............. <br />Consideratian paid for Real Estate .........................s ,,. x'20.00 <br />Certification <br />~~ k, the undersigned, having personal knowledge of this transaction. carttf} that the Coregoing is true ' <br />and c,otrect. ~' ~ <br />Signatur .... ....... .... .... ~, <br />I V E: <br />~? Capacity .., 1..• ................................... •-- •-~ <br />!~ I <br />C ---~ ~ <br />~.~ <br />eznaee-re-at~ Nea. r,. .n <br /> <br /> <br />J <br />