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N—� D r",.._) (1) r . ) • _ 73 y N NM =z) __I r 71 r't F—' r...) - Co O') co --1 F—► .-? — - f"1 1 _ .Z D CO Q ..-J= r�� irn —4 1Tl rn cCn Return to: Kevin P. Walsh 104 N. Wheeler Avenue Grand Island, NE 68801 AFFIDAVIT FOR TRANSFER OF REAL PROPERTY WITHOUT PROBATE UNDER NEBRASKA PROBATE CODE The undersigned Affiant, being first duly sworn, does hereby depose and state pursuant to NEB. REV. STAT. §30-24,129 as follows: 1. The value of the one-sixth (1/6) interest held by JAMES A. MARTINEZ, Deceased, in the following described real estate did not exceed the sum of Fifty Thousand and No/100 Dollars ($50,000.00) as the then current assessed valuation of the entirety of said real estate on the date of his death as shown on the assessment rolls in the Office of the Hall County Assessor for the year 2016 was Eight Thousand Three Hundred Eighty -Two and No/100 Dollars ($8,382.00): The East Sixty -Three and Five Tenths (63.5) feet of Lot One (1), Block Seventy - Two (72), Original Town, now City, of Grand Island, Hall County, Nebraska. 2. Thirty (30) days have elapsed since the death of the Decedent on December 27, 2016 as shown by the certified copy of the decedent's death certificate attached hereto as Exhibit "A" and incorporated herein by this reference. 3. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 4. Affiant, as the surviving spouse and beneficiary under the Last Will and Testament of James A. Martinez, Deceased, is entitled to the real property described hereinabove at Paragraph 1 by virtue of intestate succession or devise under the will of the decedent. 5. Affiant has made an investigation and has been unable to determine any subsequent will. 6. No other person has a right to the interest of the Decedent in the real estate described hereinabove at Paragraph 1.