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AFFIDAVIT <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />87--- 146048 <br />Affiant, Terry Loschen, after being duly sworn upon <br />oath, does depose and state as follows: <br />1. That affiant is the licensed embalmer signing the <br />Death Certificate, attached hereto, marked Exhibit "A" and <br />incorporated herein by reference, and is accordingly personally <br />aware of the death of Leonard Michael Shotkoski on May 6, 1986. <br />2. That on the date of death, Leonard Michael <br />Shotkoski, married to Miyoko Shotkoski and to the affiant's <br />knowledge was a joint tenant with her having a right of <br />survivorship in the real estate located in Hall County, Nebraska, <br />and legally described as follows: <br />The West One Half (Wj) of Lot Six (6), of Vantine's <br />Subdivision, in the City of Grand Island, Hall County, <br />Nebraska. <br />3. That this Affidavit is given as evidence that <br />pursuant to Nebraska Revised Statutes S 77 -2003 no inheritance <br />tax lien arising due to the death of decedent can attach to the <br />above - described real estate and that pursuant to Neb. Rev. Stat. <br />$ 77 -2012 no Nebraska estate tax lien arising due to the death of <br />decedent can attach to the above - described property. <br />FURTHER AFFIANT SAYETH NOT. <br />Dated this _A^ day of September, 1987. <br />IN <br />