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EMNIIMIMMMa 77 nn => C r71 N 7--. n n s CO cnz x co n v iXI n :0 T1 N `D '`./ Return to: WNMOG 1228 L Street urora, NE 68818 AFFIDAVIT AND DEATH CERTIFICATE STATE OF NEBRASKA ) ) ss. COUNTY OF HAMILTON ) Affiant, Larry L. Brummund, after being duly sworn upon oath, does depose and state as follows: 1. That Affiant is the surviving spouse of Kathy M. Brummund, deceased, who departed this life on May 13, 2020, as shown by the certified copy of the death certificate attached hereto and by this reference incorporated herein. 2. That on the date of death, the Affiant and decedent were the sole owners as joint tenants with right of survivorship of that real estate legally described as follows: Lot Seventeen (17), in Bartelt Subdivision to the Village of Doniphan, formerly known as part of Lots Seven (7), Fifteen (15), Sixteen (16), Seventeen (17), and Eighteen (18) of the County Subdivision of part of the South Half (S'/2) of Section Five (5), Township Nine (9) North, Range Nine (9) West of the 6th P.M., in Hall County, Nebraska; and An undivided interest in and to the Southeast Quarter (SE'/4) of Section Twenty-three (23), Township Nine (9) North, Range Ten (10) West of the 6th P.M., in Hall County, Nebraska; and An undivided interest in and to the Southwest Quarter (SW1/4) of Section Twenty-six (26), Township Ten (10) North, Range Nine (9) West of the 6th P.M, Hall County, Nebraska. 3. That by virtue of the survivorship of Affiant, Affiant became the sole owner of the above-described property. 4. That this Affidavit is given as evidence that pursuant to Neb. Rev. Stat. §§77- 2003 and 77-2004, the above described real estate is not subject to Nebraska Inheritance Tax and, as property passing from decedent to his spouse, said property is not subject to any lien for Nebraska Inheritance Tax. ON IN3W11111SNI SY 031131N3