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.,. -- e -- 200510817 Succession of Real Property by Affidavit for Small Estates Nebraska Revised Statutes Section 30-24,129(2000) STATE OF IOWA ) )ss COUNTY OF MILLS ) COMES NOW, the undersigned, Miguel Moreno, being dully sworn, deposes and says that the Undersigned knows the Decedent and the successors of the Decedent and that the following information Is true and correct: 1. Name of Decedent: Louise Moreno Date of Death: January 3, 2005 Domicile at date of Death: Grand Island, Nebraska Name of Surviving Spouse: No surviving spouse Date of Marriage: N/A 2. The- Affiant is tin; SUIl of1he-DeeedeM, - - -- -- 3. There is no Federal Estate Tax, Nebraska Inheritance Tax, or Nebraska Estate Tax. 4. Title to the following described real estate is held by the Decedent, to wit: (See Addendum # I) 5. As of the date of death, the Decedent's interests in the above real estate had a fair market value ofless than $100.00. 6. The value of the Decedent's interest in all real property in the Decedent's estate located in Nebraska does not exceed $25,000.00. The value of Decedent's interest as determined from the value of property as shown on the assessment roles for the year in which the Decedent died is less than $100.00. 7. Thirty days have elapsed since the death of the Decedent as shown by a certified or authenticated copy of the Decedent's death certificate attached to this affidavit; 8. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 9. The claiming successor is entitled to the real property by way of Joint Tenancy Warranty Deed. 10. No other person has a right to the interest of the decedent in the described property; 11. The claiming successor is a surviving spouse of the Decedent and the value of the entire estate of the Decedent as ofthe date of her death was less than $25,000.00; 12. And the claiming successor under this affidavit swears or affirms that all statements in the affidavit are true and material and further acknowledge that any false statements may subject the undersigned to penalties relating to perjury under Nebraska Law, Nebraska Revised Statutes Section 28-915.