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� <br />� <br />� �� <br />201204231 <br />AFFIDAVIT <br />STATE OF NEBRASKA, COUNTY OF HALL, ss. <br />Affiant, Marlene A. Mead, aka Marlene Mead, after being first duly <br />sworn upon oath, deposes and states as follows: <br />1. That Affiant is the surviving spouse of Donald Duane Mead, who departed <br />this life on April 8, 2012, as shown by the certified copy of his Death <br />Certificate, attached hereto as Exhibit "A" and by this reference <br />incorporated herein. That Donald Duane Mead was also know as Donald <br />Mead. <br />2. That on the date of death, the Affiant and Decedent were the sole <br />owners, as joint tenants and not as tenants in common, of the real <br />estate described as follows: <br />Lots One (1) and Two (2), Block Eight (8), in MacColl and Leflangs <br />Addition to the Village of Wood River, Hall County, Nebraska <br />Subject to easements, restrictions, covenants, reservations and <br />streets of record, if any <br />3. That by virtue of the survivorship of Affiant, Affiant became the sole <br />owner of the above-described property. <br />4. That this Affidavit is given as evidence that pursuant to Neb. Rev. <br />Stat. Sec. 77-2003 (Reissue 2009), no inheritance'tax lien arising due <br />to the death of Decedent can attach to the above-described real estate. <br />5. That the gross estate of Decedent was less than the amount exempt from <br />Federal Estate Taxes. <br />FURTHER AFFIANT SAYETH NOT. <br />,�� � <br />Marlene A. Mead, aka Marlene Mead <br />Subscribed and sworn to before me this ��day of �GL , 2012. <br />r � <br />Notary Public <br />My comm. egpir ��� <br />BRIAN L. HAYES <br />My Comm. Exp, April 6, 2016. <br />aff.dc.doc <br />