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<br /> �`, � AFFIDAVIT OF DEATH OF — --
<br /> STATB OF NSHRASRA )
<br /> � � S'=' � ) ss e J D I N T T'�•N A D t'I' � �x-'_
<br /> . . ' � CBUNTY OF AAI�L ) • �" -
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<br /> �':�• � IAUIS PESEK, Jlt., loeing first duly sworn on his oatb, depos�s �C �ky.
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<br /> � �� ancZ says tBiat he residss at �829 t,T. iith A�renue, Grand Island� H�lI _ -.:
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<br /> ,�' '�'' ' Ccunty, &��rasYsa. His wife, Helen L. �c�sek died Septetmber 2�, _ ,a:;=�
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<br /> �.�{s• .'�, 199T, in Grand Island, PTebraeka. _ 6°:,�
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<br /> ., Yteal estate wtiich f.ha parties owned isi j�i.nt tena,naY is � _.
<br /> ' . � desc�ibed as Yollaws: � � ' --
<br /> �;;i: . � � L�t Eight (8) i�n Block Sev� (Tj, Boggs &.HiA� Additibn, -
<br /> '.� `.'` . � fn the Ci�y of Gsartd islaar�� .Hall County, Nc��aska►. ,
<br /> , ,,•..'.�' : . �,� �otal value vf all pr�g�x�y oF�ned by the aecedent valued T^:-=
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<br /> °y�..<<��;-�,:r�. �.= at the fair market value css� th� �ate of her deatY�, �id no� equal oz .
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<br /> `����t�-'` .�roaah the s� of ,�540 000 asid that there�: ,�.s no Nebraska , _�--
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<br /> , '.,,,:' , ; ` inher3�tance tax or Fede�B �state �ax due or ocaing herein for the . ,:,: ---
<br /> . . .� ._ . .,� . -
<br /> � � , � ; .;. � . � reasan t�a� all oP the D��dent's asse�s gassed �o �he undersigned, �
<br />- • . � `��c surviving spouse on �hhe date of rier deatch. � '
<br /> . ' DATED: OCtobe� 8, 1997. � .
<br /> • � � '1 , Pese�r. � _..
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<br /> ; :& � . � .SLTpSCRIBED anal �waa� �o before m� a Notary Public tiz�'8th day ^_-
<br /> .� c3f OCtObsr, 199�`.. . ' �:.
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