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STATE OF NEBRASKA�� COUNTY OF �'fv�K. cry 0 0 NEBRASKA S Date /b T DOCUMENTARY P TA5 X -(l By dr IHST 10211 0 b 3 b AFFIDAVIT OF TRANSFER OF REAL PROPERTY WITHOUT PROBATE UNDER NEBRASKA PROBATE CODE ) ss. The undersigned Affiant, upon being first duly sworn, does hereby depose and state: i. The value of the entire Estate ofJEROME F. PACKER, Deceased, wherever located, less liens and encumbrances, which is subject to probate proceedings, does not exceed $100,000.00. 11. The value of the decedent's interest in all real estate located in this state does not exceed $100,000. iii. Thirty (30) days have elapsed since the death of the Decedent as shown in a copy of the decedent's Death Certificate, marked Exhibit "A", attached hereto and incorporated herein. iv. Affiant is the surviving spouse of decedent. v. No application or petition for the appointment of a Personal Representative is pending or has been granted in any jurisdiction. vi. Affiant is entitled to payment and delivery of all property held by others in the sole name of the Decedent pursuant to Nebraska Probate Code Section 30-24,125. vii. Pursuant to Nebraska Probate Code Section 30-24,126, the person paying, delivering, transferring or issuing personal property or the evidence thereof pursuant to this Affidavit is discharged and released to the same extent as if said person dealt with a Personal Representative of the Decedent; said person is not required to see to the application of the personal property or evidence thereof or to inquire into the truth of any statement in this Affidavit. viii. All statements herein are true and material and Affiant further acknowledges that any false statement may subject Affiant to penalties relating to perjury under Neb. Rev. Stat. §28-915. The undersigned, as surviving spouse of the decedent, is entitled to the real property by reason of the homestead allowance, exempt property allowance, and by devise into the will of the decedent. ix. No other person has a right to the interest of the decedent and the described property. x. The real property owned by the decedent on his date of death and interest of decedent in the property is as follows: An undivided % interest in and to the attached Exhibit "B." Which, as of today's date, has an assessed value of $11,000, making the decedent's interest therein, no more than $11,000. CASH CHEC Agra. REFUNDS: CASH HALL COUNTY NE oc - 1; 10: 15 V'!CLD REGISTER OF DEEDS z$�