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111 <br />n c <br />z <br />=no <br />co <br />Once recorded, please return to: <br />Parker, Grossart & Bahensky, L.L.P. <br />PO Box 1600, Kearney, NE 68848-1600 <br />(In <br />=> <br />M= <br />AFFIDAVIT OF <br />SURVIVING SPOUSE <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF BUFFALO ) <br />is <br />c:) <br />r Ti <br />• <br />CJS .0 <br />L� <br />Affiant, Elaine E. Graham, after being duly sworn upon oath, does depose and state <br />as follows: <br />1. That affiant is the surviving spouse of Paul E. Graham (hereinafter referred to as <br />the "decedent"), who departed this life on September 7, 2017, as shown by the copy of the <br />death certificate attached hereto as Exhibit "A" and by this reference incorporated herein. <br />2. That on the date of death, the affiant and the decedent were the sole owners as joint <br />tenants with rights of survivorship of that real property described as follows: <br />Lot 2, Graham Subdivision in the City of Grand Island, Hall County, <br />Nebraska. <br />3. That by virtue of the survivorship of affiant, affiant became the sole owner of the <br />above-described property. <br />4. That this affidavit is given as evidence that pursuant to Neb. Rev. Stat. §77-2003 <br />(Reissue 2009) no inheritance tax lien arising due to the death of the decedent can attach to <br />the above-described real estate. <br />5. That no federal estate tax return has or will be filed as the gross estate of the <br />decedent was less than that amount necessary to require the filing of such a return pursuant <br />to Internal Revenue Code §6018. <br />Dated: January 23, 2020. <br />?jet 11.1j141t'S <br />laine E. Graham <br />SUBSCRIBED AND SWORN to before me on January 23, 2020. <br />GENERAL NOTARY - State of Nebraska <br />DAMON T. BAHENSKY <br />r1 My Comm. Exp. August 30, 2021 <br />Notary Public <br />ON 1NJWfl 1SN1 Sd 031131ht3 <br />