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The undersigned, being first duly sworn, upon oath deposes and <br />says: <br />A. ROSE L. HAUSCHILD is the surviving spouse of OTTO C. <br />HAUSCHILD who died JANUARY 26, 2001. A copy of the <br />certified death certificate for said decedent is set forth <br />on the reverse side hereof. <br />B. The following property passed from said decedent to said <br />decedent's surviving spouse as provided in N.R.R.S. Section <br />77 -2001 through 77 -2004 and Section 77 -2101, to -wit: <br />LOTS THREE (3) AND (5), IN BLOCK TEN (10) IN COLLEGE <br />ADDITION TO WEST LAWN, IN THE CITY OF GRAND ISLAND, <br />HALL COUNTY, NEBRASKA. <br />And further affiant sayeth not. <br />ROSE L. HAUSCHILD <br />Subscribed and sworn to before me this 2004. <br />GENERAL NOTARY - State of Nebraska <br />I LINDA NIELSEN <br />My comm. Ev. May 17, 2006 <br />otary Publ c <br />My commission expires: <br />/40­0 <br />I <br />M <br />= <br />D <br />Z <br />M <br />CA <br />_ <br />vV <br />T > <br />rr f <br />C= <br />�aA <br />%_ <br />N <br />O <br />N <br />Qka <br />CD <br />C7 <br />D 03 <br />O <br />tQ <br />M <br />3 <br />r <br />C <br />N <br />AFFIDAVIT <br />c°n <br />co <br />p <br />►—' <br />CD <br />OF NEBRASKA ) <br />W <br />Q <br />�I'STATE <br />200403910 <br />COUNTY <br />OF HALL <br />The undersigned, being first duly sworn, upon oath deposes and <br />says: <br />A. ROSE L. HAUSCHILD is the surviving spouse of OTTO C. <br />HAUSCHILD who died JANUARY 26, 2001. A copy of the <br />certified death certificate for said decedent is set forth <br />on the reverse side hereof. <br />B. The following property passed from said decedent to said <br />decedent's surviving spouse as provided in N.R.R.S. Section <br />77 -2001 through 77 -2004 and Section 77 -2101, to -wit: <br />LOTS THREE (3) AND (5), IN BLOCK TEN (10) IN COLLEGE <br />ADDITION TO WEST LAWN, IN THE CITY OF GRAND ISLAND, <br />HALL COUNTY, NEBRASKA. <br />And further affiant sayeth not. <br />ROSE L. HAUSCHILD <br />Subscribed and sworn to before me this 2004. <br />GENERAL NOTARY - State of Nebraska <br />I LINDA NIELSEN <br />My comm. Ev. May 17, 2006 <br />otary Publ c <br />My commission expires: <br />/40­0 <br />I <br />