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86- 100705 STATE OF NEBRASKA ) AFFIDAVIT OF DEATH COUNTY OF HALL ss. TO CLEAR TITLE ) ROBERT H. KOCH, being first duly sworn on his oath, deposes and says: 1. That his wife, Alberta R. Koch, died October 24, 1986, a resident at 2723 West Prospect, Grand Island, Hall County, Nebraska. 2. No proceedings for probate of her Will nor admin- istration of her Estate has been commence4 and none is con- templated. By the provisions of her Will, all assets in which she had any interest were devised to Robert H. Koch, this Affiant. The sole heir -at -law of the Decedent is Robert H. Koch, this Affiant and the surviving spouse of Alberta R. Koch. 3. The only property in which the Decedent owned any interest at the time of her death was real estate and per - sonal property owned in joint tenancy by the Decedent with her surviving spouse, Robert H. Koch. The description of such real estate so owned by the Decedent with this Affiant is: The East 60.3 Feet of (both) Lots Two (2) and Four (4), all in Block Fourteen, in University Place, an Addition to the City of Grand Island, Hall County, Nebraska. 4. Inasmuch as ail assets in which the Decedent had any interest passed to this Affiant, Robert H. Koch, the sur- viving spouse of the Decedent, no Nebraska Inheritance max could be due or payable by Robert H. Koch. 5. The total value of all assets subject to computation in determining the gross value of Federal Estate Tax property is substantially less than $500,000. No Federal Estate Tax Return is, therefore, required, and there is no Federal Estate Tax due or owing herein. DATED this 20th day of November, 1986. ROBERT KOCH SUBSCRIBED and SWORN to before me this 20th day of November, 1986. My Notarial Commission expires: 2 -4 -88. Notary Public W M -ame r MAtnu ARMA G MAYER �a E*Fek4.IM