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004-393
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I3_ <br />STATE OF NBRASKA, <br />COUNTY OF Adams SS: <br />__ Floyd a. Butte= the undersigned, <br />being first duly sworn on oath deposes and says: <br />1. That he is the partner in Ownership of the <br />Livingston - Butler- Volland Funeral Home, 5th and Lincoln, <br />Hastings, Nebraska, a Mortuary , engaged in conduct of Funeral and <br />Burial_ Services, also Ambulance Service. , <br />organized under the Laws of the State of Nebraska <br />2. That he is autbo.rized by the aforesaid Livir:gstor- <br />Butler - Volland. Funeral Home to execute on its behalf this <br />affidavit. <br />3. That according to the records of the Livingston- <br />Butler- Volland Funeral Home, which records were kept in the <br />i <br />ordinary course of business, one Ff,,WA HORACEK, whose address is <br />Ishown to have been Amherst Nebraska , and <br />whose date of birth and place of birth is shown to have been <br />Dec , 1$9 t- Michael. Nebraska s passed away on March 17, <br />1953, and was by the said Livingston- Butler - Volland Funeral <br />Home interred, and that, according to said records, surviving <br />her she left her husband, Anton Horacek, and three children, <br />Anton A. Horacek, Hubert J. Horacek, and Barbara L. IIoracek. <br />4. That he makes this affidavit evidencing the passing <br />away of 1�rnrra Horacek for use in clarifying title to real estate <br />situate in the County of Hall, State of Nebraska, described as <br />follows, to wit, <br />The east one -half of the Northeast ') uarter (7-?� NE I-) of <br />Section Thirty -one (31), in Township Twelve (12), North, <br />of Range Twelve (12), !:'rest of the Sixth (6th) P.y. <br />Further affiant saith not. <br />¢yam Subscribed and sworn to before me th' 4th day of February , <br />Not Pub]_i <br />
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