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<br /> 97�- iA4'722
<br /> AFFIIDAVIT OF IO�i�il'd'AL S'�ATUS �
<br /> STATE OF NEBRASKA )
<br /> )ss.
<br /> �nt rntTV�1'�i�i4i�i. )
<br /> VMVw�� �
<br /> COME5 NUW,the undaeigned,be'Ing duly awom,depnse��d s�ys t6at the
<br /> undereignad knowa the Decedart tnd the survivin6 spouse of the Decedent and Zha�t the
<br /> following inSorn�ation is true dnd correct:
<br /> 1. Nane ofDeceddrt: George Willi�m Giese,Jr.
<br /> I)�te of I)atth: Jena�ry 17, 1996
<br /> Domicile�t Dste of Da�th: Grand Yslu�d,Hail Ccxwty,Nebrasica
<br /> N�e o£Sumving Spouee: I.etnor W.Gieu
<br />- Uuc of MAn�iage: Fdmury I 1, 1940.
<br /> 2. TThe�►ffiaat is cetstaf to the Decedent ss followa: Son.
<br /> 3. T4a�e is no Fedaal Estate"i'�uc,NebrASica Inheritanee Tax or NeMxslu Est�te Tax.
<br /> 4. Ti�e to the Fol�owing described real es�te is hdd by the Deca1'mt e�nd the
<br /> s�uviving sp�use of the Decedent in joint t�y,tawit:
<br /> Lot One(1)in Block Ten(10),in Ashton Place Addition to the City ofCm�ntl
<br />� =-Z.�l,;,i�:t!:,:,�i.~�-},:`:..�vi�.i�r.
<br /> 5. As of dste of dath,the nal�stnte has a fair cn�cica vslu�of 5115,610.Q0.
<br /> 6. 'I�e Dec.ederrt u�d I�earwr l�V. Cmse were rtu�rried as of dste of dath. 7'i�r+e ia no
<br /> 3�id�ruks Inhaitanx Tax�ien by t+eason of Nebrasks R�vieed Sututea ,
<br /> Section 77-2003. '�'l�ene is no NebrsalCa E ax liea by rerson of Nd�raska
<br /> Revised Statutes Section 7?-2102.
<br /> I�[iRTE�ER Affisnt e�ith not. ' �
<br /> Jay
<br /> Subxiibod and sworn to before me this /��y of 7une, 1997.
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<br /> iFJr� JANIE SCHU�/
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