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N S S 0) S ""-J ~ CD CO I'''....."J ga ~.':..,",":Jo 0 (f) t~~',:"~ 0 (;:.;r, 0 ~ [ c: ):::- rv -- ..~. ~ z ......; c.~~ -~ rn C) GJ -< 0 a;- N 0 "'Tl C) N -'1 ......,- 0') - -'- Ii) ~ ::0 :t~ G~ C) ::3 ,-- ~) r :r~ -...J I-' (fl .J: ~ I--' 7_ l>- eD Ul ---- '-" U1 (f) CO Z (Ill Q ~ Ci1~~ tfO"", ",.. ~~~ en ..~ 01 Oo~... ~OO ~ ~ !;"-;.) ~::.~ t~~ C) ~\ (/) (Ii (l (, Q~ m en nx '" 10 m -n c: n Z ~~~ n(l') "':c ~" ~ ~~ ~i:' :~~ C') .J"~..... C) (:~:.~ -'.1 (J\ o AFFIDA V1T2 0 0607 49<1 STATE OF NEBRASKA ) )ss. COUNTY OF HALL ) COMES NOW the following individuals, ALLEN L. BOMSTAD, JEFFREY A. BOMST AD, SCOTT BOMST AD, CAMERON BOMST AD, KRISTIN BOMST AD and PAUL BOMST AD, herein referred to as affiants and all being first duly sworn upon oath, deposes and states as follows: 1. This Affidavit is made upon the personal knowledge of the undersigned affiants of each of the facts contained in this Affidavit. 2. JACQUELINE G. BOMSTAD was married to the affiant, ALLEN L. BOMSTAD, and was the mother of the affiants, JEFFREY A. BOMSTAD, SCOTT BOMSTAD, CAMERON BOMSTAD, KRISTIN BOMSTAD and PAUL BOMSTAD. 3. That JACQUELINE G. BOMST AD died on January 2, 1993 in Hall County, Nebraska. 4. That at the time of death of JACQUELINE G. BOMST AD, she as the owner of real estate with ALLEN L. BOMST AD legally described as follows: Lot Forty-Three (43), in Belmont an Addition to the City of Grand Island, Hall County, Nebraska, also known by street number as 507 N. Carey, Grand Island, Nebraska 68801. 5. At the time ofthe death of JACQUELINE G. BOMSTAD, she owned a one- half (1/2) interest in the said real estate as tenants in common with ALLEN L. BOMSTAD pursuant to Warranty Deed dated June 16, 1992 whereby JEFFREY A. BOMSTAD was Grantor and ALLEN L. BOMSTAD and JACQUELINE G. BOMSTAD were Grantees. 6. That at the time of the death of JACQUELINE G. BOMSTAD, the real property had a value of Thirty-Five Thousand Dollars ($35,000.00) which the Decedent, JACUELINE G. BOMSTAD'S valuation as to her half interest was Seventeen Thousand Five Hundred Dollars ($17,500.00). 7. The value of the Decedent's, JACQUELINE G. BOMSTAD, interest in the real property at the time of her death did not exceed Twenty-Five Thousand Dollars ($25,000.00) and the value of the Decedent's interest as determined from the value of the property as shown on the assessment rolls for the year in which the Decedent died was Twenty-Eight Thousand Five Hundred Seventeen Dollars ($28,517.00) of which one-half (1/2) is allocated to the Decedent or Fourteen Thousand Two Hundred Fifty-Eight Dollars and Fifty Cents ($14,258.50). 8. That thirty (30) days have lapsed since the date of death of the Decedent as shown in the certified copy of the Decedent's death certificate which is attached hereto incorporated by this reference and made a part hereof as to this Affidavit. 9. There is no Application or Petition for the Appointment of a Personal Representative pending nor has one been granted in any jurisdiction. ,.,.0' SO