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(The above space for use of Register of Deeds) <br />AFFIDAVIT <br />PREPARED BY: Terry Curtiss, Curtiss, Moravek & Curtiss, PC, LLO, 416 Niobrara Ave., Alliance, Nebraska 69301 <br />STATE OF NEBRASKA, County of Box Butte: ss. <br />Mary M. Dubbs, now Mary M. Lore, being first duly sworn on oath, states: <br />1. I am the surviving spouse of Don A. Dubbs, also known as Don Dubbs. <br />2. Don A. Dubbs, died August 14, 2009, a resident of and domiciled in Grand Island, Hall <br />County, Nebraska. <br />3. At the date of death of Don A. Dubbs, he and I owned the following described real estate <br />as joint tenants and not as tenants in common: <br />The Easterly 33 feet of Fractional Lot 6 and All of Fractional Lot 7 in Fractional Block 143, <br />Union Pacific Railway Co. S Second Addition, and the complements thereto, being the East <br />33 feet of Fractional Lot 7, and All of Fractional Lot 8, in Fractional Block 11 in Russell <br />Wheeler's Addition, all in the City of Grand Island, Hall County, Nebraska. <br />4. Attached hereto is a certified copy of the death certificate issued by the State of Nevada, <br />Department of Human Resources Division of Health Vital Statistics. <br />FURTHER AFFIANT SAYETH NOT. <br />Subscribed and sworn to before me on <br />GENERAL NOTARY - Site of Nebraska <br />TERRY J. CURTISS <br />My Comm. Exp. September 30, 2017 <br />My commission expires: q/ 3, r 2 >/ <br />Mary M. Lo e <br />Notary Public <br />=a <br />n = <br />44 - X0-1.-e <br />if 11 ,2016. <br />) <br />(I <br />m <br />