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<br />AFFIDAVIT
<br />
<br />STATE OF NEBRASKA
<br />
<br />ss:
<br />
<br />COUNTY OF HALL
<br />
<br />Affiant, JAN L. SCHMIDT, after being first duly sworn on
<br />oath, deposes and states as follows:
<br />1. That Affiant is the surviving spouse of DENNIS G.
<br />SCHMIDT, who died August 15, 2005, as shown by the certified copy
<br />of the Decedent's death certificate attached hereto as Exhibit "A"
<br />and by this reference incorporated herein; that Exhibit "A" is a
<br />certified copy of the original Certificate of Death on file with
<br />the Bureau of Vi tal Statistics, Department of Health, State of
<br />Nebraska.
<br />2. That Affiant and the said Decedent were husband and wife
<br />on the date of the Decedent's death on August 15, 2005, and were
<br />on said date the sole owners as j oint tenants not tenants in
<br />common, of the real estate legally described as follows:
<br />LOT SEVENTEEN (17), BLOCK FOUR (4), OLDE MILL SUBDIVISION,
<br />IN THE CITY OF GRAND ISLAND, HALL COUNTY, NEBRASKA
<br />3. That by reason of the provisions of the Joint Tenancy
<br />Warranty Deed, Affiant became the sole owner of the above
<br />described property on Decedent's death.
<br />4. That this Affidavit is given as evidence that pursuant to
<br />Neb.Rev.Stat. Section 77-2003, no inheritance tax lien arising due
<br />to the death of the Decedent can attach to the above described
<br />real estate and that pursuant to Neb.Rev.Stat. Section 77-2012, no
<br />Nebraska estate tax lien arising due to the death of the Decedent
<br />can attach to the above described property.
<br />FURTHER AFFIANT SAITH NOT.
<br />DATED: September <_~O, 2005.
<br />
<br />day
<br />
<br />/; .
<br />.~) . dtAIUl/.x-
<br />J ). SC~ID~ Aff iant
<br />
<br />SUBSCRIBED in my presence an sworn to before me this
<br />of September, 2005."~ ~ ~~
<br />~.,L >..uJR/'~
<br />Notary Public
<br />
<br />,~D
<br />
<br />PREPARED BY:
<br />John M. Cunningham #17276
<br />CUNNINGHAM, BLACKBURN, FRANCIS,
<br />BROCK & CUNNINGHAM, Attorneys
<br />222 N. Cedar St., P. O. Box 2280
<br />Grand Island, NE 68802
<br />(308) 384-2636
<br />
<br />
<br />GENERAL NOTARY. State of NebraSka
<br />VICKI L. GEWECKE:
<br />My Cu:nm. E;;p, Jon. 24. 2009
<br />
<br />/(,,50
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