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i <br />AFFIDAVIT <br />STATE OF NEBRASKA ) <br />as. <br />COUNTY OF HALL ) <br />Affiant, Dagney M. Jorgensen, after being duly sworn upon <br />oath, does depose and state as follows: <br />1. That affiant is the surviving spouse of Henry G. <br />Jorgensen ( "decedent "), who departed this life on January 1f 1985, <br />as shown by the certified copy of the death certificate attached <br />hereto as Exhibit "A" and by this reference incorporated herein. <br />2. That on the date of death, the affiant and decedent were <br />the sole owners as joint tenants with rights of survivorship of <br />that real estate located a #23 St. James, Grand Island, Nebraska, <br />and legally described as follows: <br />Lot Twenty Three (23), Block Seven (7), Unit One, <br />Continental Gardens, An Addition to the City of Grand <br />Island, Hall County, Nebraska. <br />3. That by virtue of the survivorship of affiant, affiant <br />became the sole owner of the above - described property. <br />4. That this affidavit is given as evidence that pursuant <br />to Neb. Rev. St at. 577 -2003 (Reissue of 1986) no inheritance tax <br />lien arising due to the death of decedent can attach to the <br />above- described real estate and that pursuant to Neb. Rev. Stet. <br />577 -2012 (Reissue of 1986) no Nebraska estate tax lien arising due <br />to the death of decedent can attach to the above - described property. <br />W <br />