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.�� <br />� <br />��� <br />0 <br />� "_�'�' <br />N �. <br />0 I�� <br />v � <br />� � <br />� <br />.� <br />r <br />� <br />� <br />.�� <br />�u <br />� <br />� �. <br />� <br />CUNNINGHAM, BLACKBURN, FRANCIS, <br />BROCK & CUNNINGHAM <br />ATTORNEYS AT LAW <br />P.O. BOX 2280 <br />GR:AI�iL� ISLANL?, NE 6$�1�2 <br />Affidavit for Transfer of Real Property <br />Without Probate Under the Nebraska <br />Probate Code <br />Y � r . <br />+ <br />�ri <br />,� <br />s� <br />D <br />r <br />� :. . <br />n r�_.. <br />� ;� <br />.-�.- <br />� <br />rn �a:. <br />c� ._,. <br />u� � <br />- .� <br />rn <br />:'v <br />v (�: <br />`'i �., . <br />� �➢ ` <br />� r <br />m <br />� ' ---- <br />) <br />r ••� <br />�� <br />� <br />" <br />r-n <br />C,77 <br />N <br />CD <br />� <br />3 <br />►--� <br />F.... <br />C'� <br />Cf1 <br />� � <br />c� --� <br />c � <br />z m <br />� <br />'� O <br />v "T� <br />'�1 � <br />� rn <br />T. m <br />� � <br />r n <br />rn <br />x <br />v <br />� � <br />� <br />� <br />AFFIDAVIT FOR TRANSFER OF REAL PROPERTY <br />WITHOUT PROBATE UNDER THE NEBRASKA PROBATE CODE <br />STATE OFNEBRASKA <br />COUNTY OF HALL <br />) <br />) ss: <br />) <br />N <br />O <br />F-n' <br />�V <br />O <br />N <br />Crl <br />� <br />C <br />s <br />� <br />� <br />� <br />� <br />�4J <br />� <br />� <br />C <br />� <br />�. <br />� <br />� �, �v <br />Affiant, Elizabeth L. Jolkowski, after being first duly sworn on oath, deposes and states as <br />follows: <br />1. That Affiant is the surviving spouse of Richazd M. Jolkowski, who died November 5, <br />2011, as shown by the certified copy of the Decedent's death certificate attached hereto as Exhibit <br />"A" and by this reference i�corporated herein; that Exhibit "A" is a certified copy of the original <br />Certificate of Death on file with the Burea.0 of Vita1 Statistics, Department of Health, State of <br />Nebraska. <br />2. That �ant and the said Decedent were husband and wife on the date of the Decedent's <br />death on November 5, 2011, and were, on said date, the sole owners as joint tenants, not tenants in <br />common, of the rea1 estate legally described as follows: <br />Lot Two (2), Block Twelve (12) in Bonnie Brae Addition to the City of Grand <br />Island, Hall County, Nebraska <br />3. That by reason of the provisions of the Joint Tenancy Warranty Deed, �ant became <br />the sole owner of the above described property on Decedent's death. <br />4. That this Affidavit is given as evidence that pursuant to Neb. Rev. Stat. Section 77-2003, <br />no inheritance tax lien arising due to the death of the Decedent can attach to the above described <br />real estate and that puxsuant to Neb. Rev. Stat. Section 77-2012, no Nebraska estate ta�c lien arising <br />due tc� the de�tk� c�f the Decedent can atta.ch to the above described property. <br />FURTHER AFFIANT SAITH NOT. <br />DATED: February � � , 2012. <br />/ i � / <br />�6.i�.r� • � ' ' /' <br />�� �.�—=� <br />. �- r • • / <br />S CRIBED IN MY PRESENCE and sworn to before me by Elizabeth L. Jolkowski, <br />thi ay of February 2012. � <br />G�AI I�TASi►-y�ate � Alebraska <br />� �� �l�ItER <br />� �� � otary Public <br />