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<br /> BTATE OF 2iEBR1i18K11 ) '
<br /> � SS.
<br /> — _ COUNTY OI+' Hl1LL �
<br /> = CO1�iE6 NOW, th� undersig�ed, �Oeinq duly s�rorn, dep�oees a�►d
<br /> � s�ates that the follAwinq intormation is true and cnrreats
<br />-;�;.-
<br />-;R� 1. Name of Os�edent s Harry R. Ce�epersen -
<br />-- . Deete of De�ths Febrt�e�'y 3, 1994 _ . _.
<br /> --- - I - Damiail.� a� ��e a� Deatht Grand Island, �s11 C�unty, -
<br /> ;;� Nebraska
<br /> �
<br /> �.... Name a Survivin s ouses Sarah E. Caspersere
<br /> ';;,•,'�t;:� �:�; :
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<br /> , Date oP Marri$ges March 03, 1956
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<br /> i,�::;,, 2. The Aff iant is the Deaedent�s �urviving spouse.
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<br /> 1 "��'�`�'Y`"�`�`'�� 3 There is no �ederal Eetate Tax, Nebraska Tnheri.tance Tax
<br /> ���,;,�.:�. . , �. ' -
<br /> •�' `� �" �' or Nebraska Estate Tax.
<br /> �°':. >• ,:
<br /> �. .
<br /> � _�__ 4. Title to the Pollowing desaribed real estate is held by n}z�
<br /> "��'� " - the Deaedent and the surviving spouse af the Decedent in joint �T�-
<br /> .,
<br /> , _ ���:_
<br />_ °y� tenanay, to-wit: � .
<br />- �� �
<br />�� Lot Twelve (12) , Bloak One (1), Axt. � and Hagges Addition to
<br /> 1 . . ,, the City oP Grand Island, Hall County, Nebraska.
<br /> �� ,.
<br /> � �� „ 5. Aa of the date of death, the real estate ha� a Eair market
<br /> �: - .,_�. -,�: --- �-:, _ -
<br /> ,. �� ��� value of $29,300.00. �
<br /> ,� 6. The Decedent and Affiant were married as of the date of
<br /> ' death. There is no Ns�braska Inheritance �ax lien by reason of
<br /> � - Nebraska Revised Statutes Section 77-2003. There is no Nebr�ska
<br /> � � ' estate tax lien by reason of Nebraska Revised 3tatutes Section 77-
<br /> ' -- 2102.
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