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<br />U'J <br />t. <br />}.J <br />C> <br />Ui <br />STATE OF NEBRASKA <br /> <br />N <br />S <br />S <br />(Xl <br />S <br />(j) <br />S <br />(j) <br />...... <br /> <br />';'> :t Q ;;x:1 <br />j -J" ~. <br />? _~ m <br />?,~:3 ~ <br />~<~ . <br />ti\ . 5::,' <br />l:::)" <br />(;'- ~ ~ <br />Oc>"'--<> 1";:.. <br />- (\ (1=. <br />l1\ <br />~. ~. <br /> <br /> lla n ~ <br /> m :J: mm <br /> "TI "'V <br /> c: m CIl ("'.;: :~':'J a if> .,.0 z: <br /> n :r (.=:JI 0 ~ -t <br /> Z co <br />n '" ..... c::l>- N m <br />::I: ~ C ,:\l. '-- :z:~ :0 <br />~ "n ~ '. c= --1m 0 m <br />.~ (I) ~1 'l- I -< 0 0 0 <br />~ :J: 0,....~' '- ~ 0 ...." )::- <br /> o'~ c..n 'I Z co en <br /> """1 (-~- :::r: (''11 0 Z <br /> 0 l>- CD en <br /> rn ( ::D .- :::0 en --I <br /> rn ::3 r p. :0 <br /> 0 en 0 c: <br /> lfl ~ ;:><: ES: <br /> ~ p. en m <br /> C) ---- ......- ~ <br /> (/) ~ <br /> CD (/) Z <br /> 0 <br /> AFFIDAVIT <br /> <br /> <br />) <br />)SS. <br />) <br /> <br />COUNTY OF DOUGLAS <br /> <br />/()J5{) <br /> <br />Anne K. Burnett, being first duly sworn under oath, states as follows: <br /> <br />1. That she is the attorney for Irvin L. Congrove, surviving spouse of Carol Y. Congrove, and she <br /> <br />makes this affidavit of her own personal knowledge. <br /> <br />joint tenancy with rights of survivorship: <br /> <br />2. That Irvin L. Congrove and Carol Y. Congrove held title to the following described real estate in <br /> <br />Lot 8, Block 2, Knickrehm Second Addition as platted and recorded in Hall County, <br />Nebraska (a/k/a 112 W. 21st Street, Grand Island, Nebraska 68801) <br /> <br />copy of the Death Certificate of Carol Y. Congrove is attached hereto this Affidavit, marked as Exhibit "A", and <br /> <br />3. Carol Y. Congrove passed from this world on October 11, 2007. A true and correct certified <br /> <br />incorporated fully herein by this reference. <br /> <br />4. The Decedent and Irvin L. Congrove were married as of date of death. There is no Nebraska <br /> <br />Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska Estate Tax <br /> <br />lien by reason of Nebraska Revised Statutes Section 77-2102. <br /> <br />FURTHER YOUR AFFIANT SA YETH NOT. <br />DATED this 2 ~ ~day of June, 2008. <br /> <br />~f:i$fff!!/ / - <br /> <br />?(of':; <br />Subscribed and sworn to before me this ~da of June, 2008. ~./ <br /> <br />GENERALNOTARY-StateofNebraska _~y ~ <br />DARREN R. CARLSON otary Public <br />My Comm. Ellp. Feb. 3, 2009 <br /> <br />