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1'n <br />_C rn Lr <br />CZ) <br />co C=) <br />C= 3> <br />M <br />.7, <br />2 <br />=X3 C=) <br />7S C) <br />M <br />Q <br />a) C=) <br />rn <br />D r- r- M 17) C3 <br />3> <br />C> C=) 7C CD <br />C_n cf) <br />Cn <br />200101611 <br />STATE OF NEBRASKA <br />AFFIDAVIT OF DEATH OF JOINT TENANT <br />COUNTY OF HALL <br />Charlotte L. Monson, being first duly sworn on her oath, deposes and says that she <br />resides at 2427 W. North Front Street, Grand Island, NE 68803; that her husband, Mervyn <br />Harold Monson, Sr., died December 24, 2000, in Grand Island, Hall County, Nebraska; <br />that her husband left no real estate separately owned by him and that all property subject to <br />consideration and computation for determination of any Nebraska inheritance tax and <br />federal estate tax was property owned by the decedent in joint tenancy with your affiant, his <br />surviving spouse; that the total of all such property as of December 24, 2000, did not equal <br />or approach the sum of $675,000 and that there is no Nebraska inheritance tax nor federal <br />estate tax due or owing by this affiant by reason of property passing to her upon the death of <br />Mervyn Harold Monson, Sr. on December 24, 2000. <br />Real estate owned by the parties in joint tenancy is described as follows: <br />Lot Five (5) in Block Twenty-four (24) in Packer and Barr's Second <br />Addition to the City of Grand Island, Hall County, Nebraska. <br />Charlotte L. Monson <br />SUBSCRIBED and SWORN TO before me, a Notary Public, this 2 day of <br />March, 2001. <br />OBEK NOTARY-State of Nek&W <br />DUANEA.BURNS <br />VI Conan. EV. March 28, 2001 <br />Notary Public <br />