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__ � �� �� � �= � .� N �� 0 � � -P �� �� �� �� �.� s �� Retum to: � CUNNINGHAM, BLACKBURN, FRANCIS � BROCK & CUNNINGHAM 222 N. Cedar St. Grand Island, NE 68802 Affidavit � C �� � � tl A �'� �., .`.: : � � S � .� � �� r �� �..� . �... � '� N � � i � � � ^' r J � �� m 3 � f --► , � �� � �.� 'r+ ....0 �r � � � AFFIDAVIT e� cn o� �a � m �-�I � O O �1 T Z = m D �7 r � r n � � Ya � cn � �F �;� �= �� �J F .?�� E,�' s� ��.� n.�,=� �� � COMES NOW, the undersigned �ant and being first duly swom upon oath deposes and states as follows: 1. Name of Decedent: Larry Eugene Wirth; Date of Death: July 25, 2011; Domicile at Death: 106 W 18� Street, Grand Island, NE 68801; Name of Surviving Spouse: Peggy A. Wu�th. 2.� The undersigned Affant is the wife of the Decedent, Lany Eugene Wirth and is the surviving joint owner of the real estate legally described as: The East Half (El/2) of Lot Twenty-Six (26) and all of Lot Twenty-Seven (27), Block Two (2), Morris Addition to the City of Grand, Hall County, Nebraska. 3. Attached hereto as Exhibit A incorporated herein by reference there appears a Certified Copy of the Decedent's Death Certificate. 4: There is no Nebraska Inheritance Tax Lien by reason of Nebraska Revised Statute, Section 77-2033; and no Nebraska Estate Tax by reason of Nebraska Revised Statute, Section 77-2102. 5. As of the date of death of the Decedent, the real estate described above had a fair market value of $120,000.00. FLJRTI�R �ant sayeth not. � O 4--�� N � N N � ..0 �� /� � � ,; ; �i �� L �•/ '-.. ' �= � � � . � SLIBSCRIBED and swom to before me the � day of d.''' , 20 ��. . • � Nota ' �� �� ;