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mn n c n= n c Ir0 x rn m cn CL. Return to: Jamie Mues Jankovitz 202 W. 3rd St. Grand Island, NE 68801 Affidavit for Transfer of Real Property without Probate I, Rita Muir, under penalty of perjury (Nebraska Revised Statute §28-915), affirm the following to be true: 1.) Thirty days have passed since the death of Terry Glen Muir, and I have attached to this affidavit a certified or authenticated copy of the death certificate; 2.) The deceased is the owner of the real property described as: Lots Ten (10), Eleven (11), and Twelve (12), Block Two (2), Pleasant Hill Addition to the City of Grand Island, Hall County, Nebraska. AND Lots Thirteen (13) and Fourteen (14), in Block Two (2), in Pleasant Hill Addition to the City of Grand Island, Hall County, Nebraska. (Physical address -1015N Poplar St., Grand Island, NE); 3.) Based on the assessed value of the real property through the County Assessor/Register of Deeds in the year of death, less real estate taxes and interest on the real estate taxes if any is due at the time of death, the value of all the real property in Nebraska belonging to the deceased is $50,000.00 or less and the value of the entire estate is $37,111.67. 4.) There is no Personal Representative, application for Personal Representative, or petition for Personal Representative either pending or granted in another court; 5.) X I am the surviving spouse of the deceased and am entitled to the real property by reason of the homestead allowance, exempt property allowance, family allowance, or by intestate succession pursuant to Nebraska Probate Code §30- 24, 129 OR ( ) I am entitled to the real property per the will of the deceased and I have made an investigation and have been unable to determine any subsequent will; 6.) No other person has a right to the real property; 7.) I will file this affidavit with the Register of Deeds Office of the county in which the real property is located (Hall County); and 8.) I will file the affidavit and certified or authenticated copy of the death certificate in any other county in Nebraska in which the deceased owns real property that is subject to this affidavit. Attachment: Certified or authenticated copy of Death Certificate Page 1 of 2