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AFFIDAVIT OF <br />SURVIVING SPOUSE <br />STATE OF NEBRASKA) <br />) SS: <br />COUNTY OF HALL ) <br />201905223 <br />Affiant, Sandra M. Krolikowski, also known as Sandra Krolikowski, after being duly sworn upon oath, <br />does depose and state as follows: <br />1. That affiant is the surviving spouse of Norman R. Krolikowski, also known as Norman Krolikowski <br />(hereinafter referred to as the "decedent"), who departed this life on March 30, 2019, as shown by <br />the certified death certificate attached hereto as Exhibit "A" and by this reference incorporated <br />herein. <br />2. That on the date of death, the affiant and the decedent were the sole owners as joint tenants with <br />rights of survivorship of that real property described as follows: <br />An undivided full interest in and to the South Loup TWP Meith Second Subdivision Lot 1. <br />Hall County, Nebraska. <br />An undivided full interest in and to the South Loup TWP PT Northeast Quarter (NE %) of <br />Section Twenty Seven (27), Township 12 North, Range 12 West, Hall County, Nebraska. <br />3. That by virtue of the survivorship of affiant, affiant became the soul owner of the above-described <br />property. <br />4. That this affidavit is given as evidence that pursuant to Neb. Rev. Stat. 77-2003 (Reissue 2009) no <br />inheritance tax lien arising due to the death of the decedent can attach to the above-described real <br />estate. <br />5. That no federal estate tax return has or will be filed as the gross estate of the decedent was less than <br />the amount necessary to require the filings of such a return pursuant to Internal Revenue Code 6018. <br />Dated: August ?Si , 2019 <br />Sandra M. Krolikowski <br />SUBSCRIBED AND SWORN to before me on August o1-17, 2019 <br />1-6 r;z0it <br />Notary Public <br />A GENERAL NOTARY • State of Nebraska <br />DEBBIE R. FOIGHT <br />� 4`. My Comm. Exp. November 29, 2022 <br />