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Executed this day of October, 2003. <br />Daniel L. Werner (Bar ID #15880) <br />Attorney at Law <br />P.O. Box 28 <br />Hebron, Nebraska, 68370 <br />(402) 768 -6109 <br />STATE OF NEBRASKA <br />ss: <br />COUNTY OF THAYER <br />20031400"1' <br />a"-^Ior lig-n �- <br />Ramon L. Mieth, Personal Representative <br />821 Olive Avenue <br />Hebron, Nebraska, 68370 <br />(402) 768 -6231 <br />The foregoing instrument was acknowledged before me on this 4P_ day of October, 2003, <br />by Ramon L. Mieth, Personal Representative of the Estate of Kathleen L. Mieth, Deceased. <br />UMM C:iT-r-y Public <br />(SEAL) <br />