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<br />~' - <br />~? - t,aMfieare a# Canvvyartee e1M~ r6oR aKds of Rsal Estme . , <br />~~~..: ~ 0 ~ ©'77 <br />This Statement is Canfidentiai and Available <br />to Taxing Officials Only <br />l;fiifi 'T'ltts fvfm )yursna#tt Ea Sectirm 76-21 R.R.S., 1943, as amended by the 75th Session of the tiebraska <br />i l.egislatute, must be completed and attached to every mortgage nr other canveyanee o! real estate <br />1 esE:e~r deeds o(rtal estate before such insitamont is filed !tx re.ardtng. <br />i <br />f!! f?'~atias to ttestrumaat ......~ixard, Lee•,3icent. Julia. C.. Akw~n, d:,,CI?!. )winaao~,~.l. $Ri'?1104i4#..IA&...... <br />1 <br />Tv#re of insttttment .,,`:,?jai Property ~oTtdaPa'e . .. !)ate .10jr7~80. Bonk .......... '• g <br />I J e ... ........... <br />i <br />~ L,.a~st~traticxo id [ 4 i= fi <br />Real Estate...,,.,,. .. Z• :,~,~,~.... <br />~~ii <br />Yt ,.. ~nmtr#licutian <br />d II E#ae uawletkNi~a~~~, tEpazvung pet~~a~~tn'atl Ikm,,o~~'fadga u~~ ;his `nnactu~n. r~ercttlc that tort tore. otn tis true <br />~~ ~~'i~mial, uaxrtect. .._........, g g <br />Signahtre .. . ,. ' <br />[ t apanti~~~~ <br />l; <br />z~ <br />t <br />_.._J <br />