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<br /> G\~C ~ n n <br /> ::r.: :t.. <br /> H ==- ~ r11 c.n <br /> b\J- c: () :J: <br /> . ~. () z x <br /> ~ ~ '; :J: n \::1 <br />N 1';\ ~ m ;p. (n <br />IS) ~~~ n (,>) ~ <br />IS) "" :J: <br />CJ'1 l") ~~ '-' <br />--... ,..-..., <br />N r 0"';; ',,/ <br />IS) ~ <br />W (..;' <br />(j) <br /> <br /> <br />AFFIDA VIT <br /> <br /> ro..::> <br /> c:" ("') (fJ <br /> <:;::::> 0... <br />~~ Co.r'l C> -j <br />c::J c ;t> f'\)'g' <br />z-j <br />,., -jm fit <br />C":I 0 <br />~~ -<0 Of! <br /> 0'1 <br />ir -J 'lz <br /> ::t: m : a;- <br />=0 1> co <br />:::3 r :n N5'" <br />r )> <br />,....... (j) en <br />0'- <br />....... ;.r;; w2 <br /> 1> <br /> c..:> -- 3 <br /> a;)_ en C??;,~ <br /> (f),. <br /> ...... <br /> 2: <br /> ~. <br /> <br />STATE OF NEBRASKA ) <br />)ss. <br />COUNTY OF HALL ) <br /> <br />The undersigned affiant being first duly sworn upon oath deposes and states as <br /> <br />follows: <br /> <br />1. That the affiant is the surviving spouse of the decedent, FREDRICK R. <br /> <br />SALAK, who died ,\.:d11Z//J'JZI!eL$l If 2 CC..s-; as shown by the <br /> <br />certified copy of death certificate attached hereto as Exhibit A and <br /> <br />incorporated herein by reference. <br /> <br />2. That at the time of the decedent's death, the undersigned affiant and decedent, <br /> <br />FREDRICK R. SALAK, were the owners in joint tenancy ofthe real estate <br /> <br />legally described as: <br /> <br />All of Lot Six (6) and the North Thirteen Feet (13') of Lot Seven (7), <br />Block Two, West Park Addition to the City of Grand Island, Hall County. <br /> <br />fl'ut' <br /> <br />3. That by virtue of the survivorship ofthe affiant, affiant became a sole owner <br />of the above described property. <br />4. This affidavit is given as evidence that pursuant to R.R.S. Neb. Section 77- <br />2003, there is no inheritance tax lien arising as a result of the death of the <br />decedent and that pursuant to Section R.R.S. ;Neb. Section77-2012, no <br />Nebraska Estate Tax Lien arises as a result of the death ofthe decedent. <br /> <br />FURTHER AFFIANT SAITH NOT. <br /> <br />DATEDthisL,gdayof i~~~ ,2005. <br /> <br />~' ~. .~ <br />/3 vz~ ~. .' au~ <br />VIVIAN MAE SA K, Affiant <br /> <br />2005. <br /> <br /> <br />GENERAL NOTARY - State of Nebraska i <br />Iii WILLIAM A. FRANCIS <br />My Comm. Exp. Dee, 31, 2007 <br /> <br />Prepared: 11-23-2005/W AF/sls <br />Probate/Salak Aff. waf <br />