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� � N � B � � � N � 0 C77 � — � � � � H � �� �� � �° � I � N T, J � ° °'9 c � � � o � �� � � � � e`1 �1' fd� � � �� r ... �G 3 c�=� c� cn r�, � :.�, o —a � �°W D CD N � � r � frj Z —1 r r', , r r � � rn O C � . � � O o e� }� �� -n i � � � . � � . � r a .` � �_� r>'_. r -= �a O p� rn y' V B —., ^� �-- ;.17 Q . '7 � f D ' �� �-�, �—r•, C.�) �c Ul � � _ f,, 1� fD r� i �' CIl � " r = � '` C�p Cn U� �� r_... rn cn i Return to: Denise D. Myers 611 N. Diers Ave., Ste. 1 Grand Island, NE 68803 AFFIDAVIT FOR TRANSFER OF REAL PROPERTY WITHOUT PROBATE UNDER NEBRASKA PROBATE CODE Section 30-24,129 STATE OF NEBRASKA COUNTY OF HALL ) ) ss. ) The undersigned �ant, upon being first duly sworn, does hereby depose and state: 1. That Henry Robert Rhoda, the decedent, died on February 3, 2011. 2. T'hat at the time of death Decedent had an undivided one-half interest in real property described as follows: Lot Two (2), Van Winkle Subdivision, in the Village of Cairo, Hall County, Nebraska. 3. The �ant, Loretta Marie Rhoda, is the person claiming as successor to the Decedent's interest in real property in the State of Nebraska, as the surviving spouse of the decedent. 4. The value of the decedent's interest in all real property in the estate of Henry Robert Rhoda, Deceased, located in the State of Nebraska does not exceed Thirty Thousand Dollars, ($30,000.00). 5. The value of Decedent's interest in the above described real estate as shown on the Hall County, Nebraska, taa� assessment rolls for the year in which the Decedent died, 2011, is $28,803.50. 6. The value of the entire estate of the Decedent, which consisted of assets in the sole name of the Decedent or in which the Decedent held an interest as a tenant in common is as follows: Real Estate Personal Property Tota1 $28,803.50 $ 0.00 $28,803.50 7. Thirty days have elapsed since the death of the Decedent, which occurred on February 3, 2011, as shown on the certified Death Certificate attached to this affidavit. 8. No application or petition for the appointment of a Personal Representative is pending or has been granted in any jurisdiction. The claiming successor's relationship to the decedent is as the �o �� surviving spouse, and therefore no inheritance tax is owed in the transfer.