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COUNTY OF HALL <br />ERNA M. SCHWARTZ, being first duly sworn on her oath, deposes and says that she �S <br />resides at 618 West 15th Street, Grand Island, Hall County, Nebraska 68801. Her husband, <br />Richard G. Schwartz died August 28, 2001, in Grand Island, Nebraska. <br />Real estate which the parties owned in joint tenancy is described as follows: <br />Lot Seven (7) in Block Fifteen (15), Schimmer's Addition to the City of Grand <br />Island, Hall County, Nebraska. <br />The total value of all property owned by the Decedent valued at the fair market value <br />on the date of his death did not equal or approach the sum of $675,000 and there is no <br />Nebraska inheritance tax or Federal estate tax due or owing herein for the reason that all of the <br />Decedent's assets passed to the undersigned, his surviving spouse on the date of his death. <br />DATED: December � 2001. <br />2001. <br />..�. <br />SUBSCR) -BED and sworn to before me a Notary Public this L day of December, <br />6ENERAI NOTARY State of Nebraska <br />I! DUANE A. BURNS <br />71 <br />(1 r) <br />Notary Public <br />M <br />-'' <br />= D <br />m cn <br />o <br />2 <br />D <br />_ <br />c> cn <br />O <br />M <br />c_n <br />n <br />►-� <br />o --� <br />ry <br />v, <br />c <br />Z —4 <br />O <br />cc <br />C-) N <br />O <br />O <br />i /� -1 1-� <br />0 <br />-n Z <br />i---A <br />a <br />� <br />O �. <br />D W <br />~ <br />M <br />s�a <br />o <br />� <br />� <br />G+D <br />N <br />200113222 <br />N <br />cc <br />cc <br />STATE OF NEBRASKA <br />) <br />AFFIDAVIT OF DEATH OF <br />c <br />ss <br />JOINT TENANT <br />COUNTY OF HALL <br />ERNA M. SCHWARTZ, being first duly sworn on her oath, deposes and says that she �S <br />resides at 618 West 15th Street, Grand Island, Hall County, Nebraska 68801. Her husband, <br />Richard G. Schwartz died August 28, 2001, in Grand Island, Nebraska. <br />Real estate which the parties owned in joint tenancy is described as follows: <br />Lot Seven (7) in Block Fifteen (15), Schimmer's Addition to the City of Grand <br />Island, Hall County, Nebraska. <br />The total value of all property owned by the Decedent valued at the fair market value <br />on the date of his death did not equal or approach the sum of $675,000 and there is no <br />Nebraska inheritance tax or Federal estate tax due or owing herein for the reason that all of the <br />Decedent's assets passed to the undersigned, his surviving spouse on the date of his death. <br />DATED: December � 2001. <br />2001. <br />..�. <br />SUBSCR) -BED and sworn to before me a Notary Public this L day of December, <br />6ENERAI NOTARY State of Nebraska <br />I! DUANE A. BURNS <br />MY COM EV. March 28' 2004 <br />Notary Public <br />