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<br /> STATE OF N�BRASKA ) AFFIDAVIT OF DEATH OF /�
<br /> � S6� JOINT TENANT �o�-
<br /> C�[7NTY OF HALL ) n7� 1U��2
<br /> :7
<br /> DONALD A. HOLST, being first duly swnrn on h�s oath, deposes
<br /> and says that he resides at 727 S. Blaine, Grand Island, Hall
<br /> County, Nebraska. His wife, Donna L, Holat died Auguat 3, 1997, in
<br /> Grand Islanfl, Nebraska.
<br /> Real estate which the part3es ownect in joinL L�no:i�y 3s
<br /> � described aB follows:
<br /> The South Twelve (12) Feet of Lot Six (6) and all of Lot
<br /> ' Seven (7) in Block Twelve (12) Parkhill 3rd Subdivision
<br /> to tha City of Grand Island, Hall County, Nebraska.
<br /> 2hm tatial vnlua of all proparty owned by the Decedent valued
<br /> a� tha lair mt�rket value on the date ot her death did not equal or
<br /> approach the sum of 5600,000 and there is no Nebraska inheritance
<br /> r tex or Federml estate tax due or owing herein Por the reason that
<br /> ell o! the Decedent�s assets passed to the undersigned, her
<br /> surviving spouse on the date of her death.
<br /> DPiTED: August�� 1997•
<br /> � DONALD A. HOIST
<br /> SUBSCRIBED and sworn to before me a Notary Public this Z-�"'
<br /> day of Auqust, 1997.
<br />-. 6ENEIGI IIO1M'f��s� � �
<br /> DifAN
<br /> �pinn�.Exp.MW+cMM� NOTARY PUBLIC
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