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D <br />NEBRASKA DOCUMENTARY <br />STAMP T <br />By UP" <br />INST /11Z3 0 5 b 5 2 <br />CASH (' era__ <br />CHECK <br />REFUNDS: <br />CASH <br />CHECK <br />RECORDED <br />HALL COUNTY NE <br />1023 OCI 2b P 3: 15 <br />KRIS11 WOLD <br />REGISTER OF DEEDS <br />C/2 as <br />Return to: Jamie Mues Jankovitz <br />308 N. Locust St., Ste. 400 <br />Grand Island, NE 68801 <br />Affidavit for Transfer of Real Property without Probate <br />nSTATE OF NEBRASKA ) <br />00 ) ss <br />COUNTY OF HALL ) <br />We, Keith Lemburg and Shawn Lemburg, under penalty of perjury (Nebraska <br />n <br />Revised Statute §28-915), affirm the following to be true: <br />1.) Thirty days have passed since the death of Owen D. Lemburg, and we have <br />attached to this affidavit a certified or authenticated copy of the death certificate; <br />2.) The deceased is the owner of the real property described as: <br />A fractional interest in and to: <br />Lot 12, Block 1 in Dodd and Marshall's Addition to the Town of <br />Wood River, Hall County, Nebraska, and A certain rectangular tract <br />of land Thirty-three feet wide adjoining the East side of Lot Twelve <br />(12), Block One (1), Dodd and Marshall's Addition to the Village of <br />Wood River, Nebraska, described as follows: Commencing at the <br />Northeast Corner of Lot 12, thence South on the East line of Lot 12, a <br />distance of 75 feet, then East on the South Line of Lot 12 extended a <br />distance of 33 feet, thence North on a line parallel to the East line of <br />Lot 12, a distance of 75 Feet, thence West a distance of 33 feet to the <br />point of beginning. (1312 Walnut St., Wood River, Nebraska.) <br />3.) Based on the assessed value of the real property through the County <br />Assessor/Register of Deeds in the year of death, less real estate taxes and interest on <br />the real estate taxes if any is due at the time of death, the value of all the real property <br />in Nebraska belonging to the deceased is $50,000.00 or less and the value of the entire <br />estate (real property value plus personal property value) is $19,864.13 less real estate <br />taxes. <br />Page 1 of 3 <br />