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IN THE COUNTY COURT OF HALL COUNTY, NEBRASKA <br />IN THE MATTER OF THE ESTATE OF <br />DANIEL J. RAINFORTH, Deceased <br />The undersigned states: <br />1. I am the wife of Daniel J. Rainforth and a named devisee of his Will, dated October 30, <br />2012. I am also a named beneficiary in his Revocable Trust dated October 30, 2012. <br />2. The assets that will pass through Daniel's Will include real estate. This real estate may <br />already be owned by Daniel's Revocable Trust. <br />3. I hereby renounce all interest that I have in all real estate, including, but not limited to, all <br />real estate listed in Exhibit "A," attached to this Renunciation, both at the time it passes <br />pursuant to Daniel's Will and at the time it is disbursed through his Revocable Trust. <br />4. I declare that this Renunciation is an irrevocable and unqualified refusal to accept in <br />whole or in part all or any part of the death benefit of these life insurance policies. <br />5. I have made this Renunciation under the provisions of the Nebraska Probate Code § 30- <br />2352 and under the provisions of the Internal Revenue Code § 2518. I have not accepted <br />any interest or benefit in, dominion over, and have not assigned, transferred nor waived <br />the right to renounce the disclaimed property, nor had such property been sold or <br />disposed of pursuant to judicial process. <br />STATE OF NEBRASKA <br />COUNTY OF 4.0• <br />s g i 201 <br />GENERAL NOTARY • State of Nebraska <br />ADAM D. PAVELKA <br />My Comm. Exp. Nov. 23, 2017 <br />) <br />) <br />) <br />SS: <br />Notary Public <br />CASE NO. PR16 -227 <br />Patricia Rainforth <br />RENUNCIATION <br />201700562 <br />The foregoing Renunciation was acknowledged before me on / l '/'" / 7 , <br />2017 by Patricia Rainforth, an interested party in the Estate of Daniel J. Rainforth, deceased. <br />