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N <br />N_ <br />CA), <br />_u <br />CO <br />0I <br />RETURN TO: <br />11 Zachary Butz <br />308 N. Locust, Ste. 501 <br />Grand Island, NE 68801 <br />r <br />C1) ^) —i <br />cn -- %' <br />r.) � r" 1 <br />r n)N -Tl <br />0`) C= <br />c» —; rn <br />f r -0 r- 23 <br />:..) D r- <br />r'- <� <br />AFFIDAVIT FOR TRANSFER OF <br />REAL PROPERTY WITHOUT PROBATE <br />STATE OF NEBRASKA ) <br />) SS: <br />COUNTY OF HALL ) <br />CJ, <br />c..) <br />I, Larry Addison, under penalty of perjury (Nebraska Revised Statute §28-915), affirm the <br />following to be true: <br />1. Thirty days have passed since the death of Cindy Addison and I have attached to this <br />affidavit a certified or authenticated copy of the death certificate; <br />2. The deceased is the joint owner of the real property described as Lot Ten (10), Block Four <br />(4), Dale Roush Second Subdivision to the City of Grand Island, Hall County, Nebraska; <br />3. Based on the assessed value of the real property through the County Assessor/Register of <br />Deeds in the year of death, less real estate taxes and interest on the real estate taxes if any is due at the time <br />of death, the value of all the real property in Nebraska belonging to the deceased is $50,000.00 or less and <br />the value of the entire estate (real property value plus personal property value) is $45,000.00; <br />4. There is no Personal Representative, application for Personal Representative, or petition <br />for Personal Representative either pending or granted in another court; <br />5. I am the spouse of the deceased and am entitled to the real property by reason of the <br />homestead allowance, exempt property allowance, family allowance, or by intestate succession pursuant to <br />Nebraska Probate Code §30-24,129; <br />6. No other person has a right to the real property; <br />7. I will file this affidavit with the Register of Deeds Office of the county in which the real <br />property is located (Hall County); and <br />8. I will file the affidavit and certified or authenticated copy of the death certificate in any <br />other county in Nebraska in which the deceased owns real property that is subject to this affidavit. <br />Date Sign <br />221 Arapahoe Ave. <br />Grand Island, NE 68803 <br />Attachment: certified or authenticated copy of Death Certificate <br />State of Nebraska, County of Hall, SS: <br />This document was acknowledged before me on the , day of <br />Addison. <br />it <br />GENERAL NOTARY - State of Nebraska <br />ZACHARY BUTZ <br />My Comm. Exp. May 16, 2021 <br />My commission expires: <br />, 2021, by Larry <br />ON 1N3WfUIISNI SY 032131N3 <br />