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<br />Cerri ficare of Conveyance other rhan Deeds of Real Esraee i <br />This Statement is Confidential and Available !, <br />I <br />to Taxing Officials Only t~ <br />Ii <br />fj <br />This Fo[m pursuant to Section 76-214 R.R.S., 1933, as amended by the 7th Session of the Nebraska <br />Legislature, must be completed and attached to every mortgage or other conveyance of real estate <br />except deeds u( real estate before such instrument is filed fur recording. <br />'irk r:....T.. '..::l:a r ~ r"~_- t..:.`--'..-........ ' _~.~nr• i..'....~ xC .~>s '^c. i ~'~. <br />Parties to Instrument _.:.. ""'"' <br />'hype of (nstrument ..:`'=:=..~=.~=r.:' °;. ; crt;".~.'. Book ............ Page ............... ' I <br />.. Data ._.......... <br />it <br />it <br />ConsidetaUUn paid for Real Estate ................ '~,._~ °o '~ <br />s _... `I <br />~, ~ ; ~ <br />i <br />'l <br />'I Certification I <br />L [fia, undersigned, having pers~mal knowledge of this [rutsactiun, certifc that the Furegoina i tnta <br />and ciirrect, '. <br />~ ~, <br />Si enanue , _ _ _ ~. _.. <br />t ;itiacrt~ ~.'. . _........... <br /> <br />