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Affiant, NORA HANSEN, after being first duly sworn on oath,
<br />deposes and states as follows:
<br />1. That Affiant is the surviving spouse of RAYMOND C. HANSEN,
<br />who died August 23, 2002, as shown by the certified copy of the
<br />Decedent's death certificate attached hereto as Exhibit "A" and by
<br />this reference incorporated herein; that Exhibit "A" is a certified
<br />copy of the original Certificate of Death on file with the Bureau
<br />of Vital Statistics, Department of Health, State of Nebraska.
<br />2. That Affiant and the said Decedent were husband and wife
<br />on the date of the Decedent's death on August 23, 2002, and were on
<br />said date the sole owners as joint tenants not tenants in common,
<br />of the real estate located at 1614 N. Elm Street, Grand Island,
<br />Nebraska, and legally described as follows:
<br />Lot Twelve (12), Abrahamson's Third Subdivision to the
<br />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 described
<br />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 real
<br />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 SAYETH NOT.
<br />Dated November ,C� , 2003.
<br />i
<br />LO) N-.
<br />SUBSCRIBED in my presence and sworn to before me this 5'
<br />day of November, 200..z.
<br />GENERAL NOTARY - State of NetuasKa
<br />JOHN M. CUNNINGHAM
<br />My Comm. Exp. Nov. 22, 2003
<br />Notaffv /Publ i
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<br />Affiant, NORA HANSEN, after being first duly sworn on oath,
<br />deposes and states as follows:
<br />1. That Affiant is the surviving spouse of RAYMOND C. HANSEN,
<br />who died August 23, 2002, as shown by the certified copy of the
<br />Decedent's death certificate attached hereto as Exhibit "A" and by
<br />this reference incorporated herein; that Exhibit "A" is a certified
<br />copy of the original Certificate of Death on file with the Bureau
<br />of Vital Statistics, Department of Health, State of Nebraska.
<br />2. That Affiant and the said Decedent were husband and wife
<br />on the date of the Decedent's death on August 23, 2002, and were on
<br />said date the sole owners as joint tenants not tenants in common,
<br />of the real estate located at 1614 N. Elm Street, Grand Island,
<br />Nebraska, and legally described as follows:
<br />Lot Twelve (12), Abrahamson's Third Subdivision to the
<br />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 described
<br />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 real
<br />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 SAYETH NOT.
<br />Dated November ,C� , 2003.
<br />i
<br />LO) N-.
<br />SUBSCRIBED in my presence and sworn to before me this 5'
<br />day of November, 200..z.
<br />GENERAL NOTARY - State of NetuasKa
<br />JOHN M. CUNNINGHAM
<br />My Comm. Exp. Nov. 22, 2003
<br />Notaffv /Publ i
<br />
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