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Affiant, LORRAINE L. SCHULTZ, after being first duly sworn on oath, deposes and states as follows: 1. That Affiant is the surviving spouse of HENRY H. SCHULTZ, JR., who died February 9, 2004, as shown by the attached copy of the Decedent's Certificate of Death, marked as Exhibit "All and made a part hereof. 2. That Affiant and the said Decedent were husband and wife on the date of the Decedent's death on February 9, 2004, and on said date were the sole owners as joint tenants not tenants in common, of the real estate legally described as follows: The North Fourteen Feet (N14') of Lot Two (2) and the South Forty -Eight Feet (S481) of Lot Three (3), in Block Sixteen (16), in West View Addition to the City of Grand Island, Hall County, Nebraska, and that the Decedent and Affiant owned certain other personal property as joint tenants, all of which passed to Affiant as surviving joint tenant. 3. That by reason of the provisions of the Joint Tenancy Warranty Deed to the above described property, Affiant became the sole owner of said described property on Decedent's death. 4. That this Affidavit is given as evidence that pursuant to Neb.Rev.Stat. section 77 -2003, as amended, no inheritance tax lien arises due to the death of the Decedent nor can the same attach to the above described real estate and that pursuant to the Statutes of the State of Nebraska, no Nebraska estate tax or inheritance tax lien arising because of the death of the Decedent can attach to the above described property, and that said described real property pass to your Affiant free and clear of any Nebraska estate and inheritance tax. FURTHER AFFIANT SAYETH NOT. Dated , 2004. LOARAINE L. SCHULTZ SUBSCRIBED in my presence L. SCHULTZ, this - day of GENERAL NOTARY - State of Nebraska B. J. CUNNINGHAM, JR. .. My Comm. Exp. August 17, 2005 rn to before me by LORRAINE :�,� , 2004. Notai'v /Public M _ _ - - o -a o P m C� --I O O Tt O Cn C-') s CD AFFIDAVIT CO z �� 0 STATE OF NEBRASKA ) 0d ss. COUNTY OF HALL ) Affiant, LORRAINE L. SCHULTZ, after being first duly sworn on oath, deposes and states as follows: 1. That Affiant is the surviving spouse of HENRY H. SCHULTZ, JR., who died February 9, 2004, as shown by the attached copy of the Decedent's Certificate of Death, marked as Exhibit "All and made a part hereof. 2. That Affiant and the said Decedent were husband and wife on the date of the Decedent's death on February 9, 2004, and on said date were the sole owners as joint tenants not tenants in common, of the real estate legally described as follows: The North Fourteen Feet (N14') of Lot Two (2) and the South Forty -Eight Feet (S481) of Lot Three (3), in Block Sixteen (16), in West View Addition to the City of Grand Island, Hall County, Nebraska, and that the Decedent and Affiant owned certain other personal property as joint tenants, all of which passed to Affiant as surviving joint tenant. 3. That by reason of the provisions of the Joint Tenancy Warranty Deed to the above described property, Affiant became the sole owner of said described property on Decedent's death. 4. That this Affidavit is given as evidence that pursuant to Neb.Rev.Stat. section 77 -2003, as amended, no inheritance tax lien arises due to the death of the Decedent nor can the same attach to the above described real estate and that pursuant to the Statutes of the State of Nebraska, no Nebraska estate tax or inheritance tax lien arising because of the death of the Decedent can attach to the above described property, and that said described real property pass to your Affiant free and clear of any Nebraska estate and inheritance tax. FURTHER AFFIANT SAYETH NOT. Dated , 2004. LOARAINE L. SCHULTZ SUBSCRIBED in my presence L. SCHULTZ, this - day of GENERAL NOTARY - State of Nebraska B. J. CUNNINGHAM, JR. .. My Comm. Exp. August 17, 2005 rn to before me by LORRAINE :�,� , 2004. Notai'v /Public