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RE- RECORDED 86� 105736 AFFIDAVIT STATE OF NEBRASKA ss. COUNTY OF HALL ) Affiant, HELEN MARIE GLIEM, after being duly sworn upon a oath, deposes and states as follows: 1. That affiant is the surviving spouse of Forest Dean Gliem, who departed this life on August 28, 1986, as shown by the certified copy of the death certificate attached hereto as Exhibit "A" and by this reference incorporated herein. 2. That on the date of death, the affiant and decedent were the sole owners as joint tenants with rights of survivor- ship of that real estate located at 1316 South Eddy, Grand Island, Hall County, Nebraska, and legally described as follows: The Northerly Eight Feet (N8') of the Easterly One -Half (E3�) of the Southerly One -Half (S�) of Block Seven (7) of Pleasant Home Subdivision a part of the East Half of the Southeast Quarter (E'SE;) of Section Twenty -One (21), Township Eleven (11) North, Range Nine (9) West of the 6th P.M., Hall Countv, Nebraska; The North Fifty -Two Feet (N52') of the South One Hundred Thirty -Two Feet (5132') of the East Half (E�) of the South Half (S�) of Block Seven (7) of Pleasant Home Subdivision of Part of the East Half of the Southeast Quarter (E'SE�) of Section Twenty -One (21), Township Eleven (11) North, Range Nine (9) West of the 6th P.M., Hall County, Nebraska. 3. That by virtue of the survivorship of affiant, affiant became the sole owner of the above- described property. 4. That this Affidavit is given as evidence that pursuant to Neb.Rev.Stat. §77 -2003 (1983 Suppl.), no inheritance tax lien arising due to the death of decedent can attach to the above - described real estate and that pursuant to Neb.Rev.Stat. §77 -2012 (1983 Suppl.), no Nebraska estate tax lien arising due to the death of decedent can attach to the above- described property. 5. That the gross estate of decedent was less than that amount exempt from federal estate taxes. FURTHER AFFIANT SAYETH NOT. ?L DATED this u day of Octtber, 1986. s v - s�.�'L � • I f W l �� Helen Marie Gliem` SUBSCRIBED and sworn to before me this day o October, 1986. J�iiM�01M�MM � � Notary /Public -- U � YJ