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AFFIDAVIT <br />STATE OF NEBRASKA ) 86- 105711 <br />) ss. <br />COUNTY OF HALL ) <br />Affiant, HELEN MARIE GLIEM, after being duly sworn upon <br />oath, deposes and states as follows: <br />1. That affiant is the surviving spouse of Forest Dean <br />Gliem, who departed this life on August 28, 1986, as shown by <br />the certified copy of the death certificate attached hereto as <br />Exhibit "A" and by this reference incorporated herein. <br />2. That on the date of death, the affiant and decedent <br />were the sole owners as joint tenants with rights of survivor- <br />ship of that real estate located at 1316 South Eddy, Grand <br />Island, [fall County, Nebraska, and legally described as follows: <br />The North Eic }ht Feet iN3'1 of the East One -Half <br />(F. ) of the South One - Hal.` S =,) of Block Sever. <br />(7), Pleasant liome Subdivision, 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 :liven as evidence that pursuant <br />to Neb.Rev.Stat. 477 -2003 (1963 �uppi.), no inheritance tax lien <br />aris:nu due to the death of decedent can attach to the above - <br />described real estate and that pursuant to Neb.Rev.Stat. 977 -2012 <br />(198., Supp1.), no Nebraska estate tax lien arising due to the <br />death of decedent can attach to the ab< >ve- described property. <br />7. rhat the _iross estate of decedent was less than that <br />amount exempt from federal estate taxes. <br />PUKMER Af'FIA.`d': SAYETH NOT. <br />DATED this ' :'ay of October, 1986. <br />Helen. Marie Gliem <br />SC'35CRIf?E and swc,.rn to before me this � � <br />da i f October, <br />Notary, 7ffbliC -- <br />/ �ar- suuRM *� <br />N)Y.i%111/ <br />