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ta_o <br />Date <br />111 E.Oq,v.A-y At M'7 333 <br />Address (line 1) <br />Wtkil'KT CPN) t' 0 i-er <br />Address (line 2) <br />Sig r <br />(do N sign UNTIL A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) <br />a„, <br />202004286 <br />Attachment: certified or authenticated copy of Death Certificate <br />NOTARY VQ) `h <br />State of Nebraska, County of Kci ‘ <br />This document was acknowledged before me on the %g� day of Sc. )'-t , 20 a <br />by L- y U ✓ A Utl (a , 11 (day) (month) (Year) <br />,/ (nom of Affiant) <br />(Seal, if any) <br />gnatureotary <br />My commission expires: I D' (c 0d" <br />Page 2 of 2 <br />Afratavit for Transfer of Real Property without Probate <br />CC 15:41 New 07/14 <br />Pro Se Committee <br />Neo. Rev. Stat §90.24.129 <br />