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?‘- 0 <br />Date <br />4001 Kay Avenue <br />Address (line 1) <br />Grand Island, NE 68803 <br />Address (line 2) <br />202101200 <br />6 n )9' 0 ./a <br />Signature <br />(do NOT sign UNTIL A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) <br />Attachment: certified or authenticated copy of Death Certificate <br />owledged before me by J //OW ki / <br />Notary commission expires: �G1C2;8 <br />Signature of Judge/' ler o he Court/Notary Public <br />Title: Serial Number (if any): <br />This docujpent was ack <br />this Q day of/ 1...,..,4•6, <br />4; / i <br />.._ �.� . A <br />eAmilGENERAL NOTARY - State of Nebraska <br />TRENNA L EDWARDS <br />My Comm. Exp. May 28, 2023 <br />Page 2 of 2 <br />Affidavit for Transfer of Real Property without Probate <br />CC 15:41 New 07/14 <br />Pro Se Committee <br />Neb. Rev. Stat. §30-24,129 <br />