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88- 101944 55. AFFIDAVIT OF DEATH OF JOINT TENANT STATE OF NEBRASY~ COUNTY OF HALL HAZEL PEDERSEN, being first duly sworn on her oath, deposes and says that she resides at 721 West John Street. Grand Island, Hall County, Nebraska 68801; that her husband. George V. Pedersen, died March 15, 1988, a resident of Grand Island, Hall County, Nebraska; that a COp~" of his Certificate of Death is attached hereto as Exhibit "Alii that her husband left no property separately owned by him, and that all property subject to consideration and computation for determination of Nebraska Inheritance Tax and Federal Estate Tax was property own~d by the Decedent in joint tenancy with your Affiant, his surviving spouse; that the total value of all such property as of March 15, 1988, valued at its fair market value on that date, did not equal or approach the sum of $600,000.00; that Affiant is entitled to an exemption in computation of either Nebraska Inheritance Tax and Federal Estate Tax of the total value of all such taxab~e property received by her by reason of the death of the Decedent, or otherwise; and that there is no Nebraska Inheritance Tax nor Federal Estate Tax due or owing by this Affiant by reason of property passing to her upon the death of Georg~ V. Pedersen on March 15, 1988. Real estate owned by the parties in joint tenancy is described as follows: lot Five (5), in Block One (1), of Bartling's Sul:division, located on part of lDt Fifteen (15) I of the County SUbdivision of the South Half of the Southeast Quarter (~sE%) of Section sixteen (16), in ~nship Eleven (11) North, Range Nine (9), and part of the Ibrth- east Quarter of the Northeast Quarter (ND-~) of Section 'IWenty- One (21), 'I'cMnship Eleven (11) North, Range Nine (9), West of t'l-}e 6tl~ P.M., Hall County, Nebraska. /Yd-fEL 7~L-'-e-.~ HAZEL' EDERSEN ft SUBSCRIBED AND SWORN day of April, 1988. to before me, a Notary Public, this ,. J:....IIIMI... II.... DUANE A. BURNS .,e.-. ~ IAJRII ZI.- ~a~ Notary Public L _J L