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.. ,z <br />-•s ; � c�.;ra <br />F' <br />... ; 7�L <br />i� <br />fir• �JSb;(r! ?tr- `+�+liN: <br />90- -10708 4 <br />AFFIDAVIT <br />STATE OF NEBRASKA, <br />Case No. P -89 -98 <br />COUNTY OF HALL <br />Alfiant, Clara Belle Klavon, after being duly sworn upon oath, <br />does depose and state as follows: <br />1. That atfiant is the surviving spouse of Edward Dale ,;,,. -.•: <br />Klavon ( "decedent "), who departed this lift on September 1, 1987, <br />as shown by the copy of the death certificate attached hereto as -- -�•t%sp, -}. <br />rg• <br />Exhibit "A" and by this reference incorporated herein. <br />2. That on the date of death, the affiant and decedent were <br />VV <br />the sole owners as joint tenants with rights of survivorship of.::` <br />that real estate located and legally described as follows s <br />Lot Fourteen (14) in Block Three (3) in Dill :;�,• <br />and Hustonts Addition to the city of Grand Island, <br />Hall county, Nebraska., _ <br />3. That by virtue of the survivorship of of f cant, of f cant <br />became the sole owner of the above - described property. <br />4. That this affidavit is given as evidence that pursuant to <br />Neb. Rev. Stat. 77 -2003 (Reissue of 1986) no inheritance tax lien <br />arising due to the death of decedent can attach to the above- ;- <br />described real. estate and that pursuant to Neb. Rev. $tat. 77 -2012 <br />(Reissue of 1986) no Nebraska estate tax lien arising due to the ,,• �r <br />death of decedent can attach to the above - described property. <br />5. That the gross estate of decedent was less than that <br />amount exenpt from federal estate taxes.� <br />n UBSCRIBED AND SWORN to b ore me this 0 day of <br />pi12Cp t , 1990. <br />�� nl�t�rroi, Notary Public <br />1 <br />