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CASH <br />CHECK 22-°° <br />L9690SZ0Z <br />RETURN TO: <br />Zachary Butz <br />308 N. Locust, Ste. 501 <br />Grand Island, NE 68801 <br />NEBRASKA DOCUMENTARY <br />STAMP TAX <br />Datel 2-1 O. 2Z2 j4 <br />$ x rip i- r1 BY. <br />INST 2075 O b q 51 <br />REFUNDS: <br />CASH <br />CHECK <br />RECORDED <br />HALL CCt..i�TY N <br />2025 GE 0 A 11: 11 <br />AFFIDAVIT FOR TRANSFER OF <br />REAL PROPERTY WITHOUT PROBATE <br />I WOLD <br />REGISTER OF DEEDS <br />We, DALE JANSSEN, WENDL JANSSEN and WESLEY JANSSEN under penalty of perjury <br />(Nebraska Revised Statute §28-915), affirm the following to be true: <br />1. Thirty days have passed since the death of David F. Janssen, and we have attached to this <br />affidavit a certified or authenticated copy of the death certificate; <br />2. The deceased is the sole owner of the real property described as Lots Five (5) and Six (6), in <br />Block Six (6), Fourth Addition to the Village of Cairo, 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 $100,000.00 or less and <br />the value of the entire estate (real property value plus personal property value) is $75,000.00; <br />4. There is no Personal Representative, application for Personal Representative, or petition for <br />Personal Representative either pending or granted in another court; <br />5. We are the brothers of the deceased and are 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. We 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 />7. We 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 <br />affidavit. <br />STATE OF Co1oc'0 ) <br />) SS: <br />COUNTY OF L c ((mC C ) <br />/// / o zs <br />Date Dale Janssen <br />777 Brussels Dr. <br />Parker, CO 80138-4602 <br />Attachment: certified or authenticated copy of Death Certificate <br />