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I\J e e CP e CP e -..J 0') G'l~ ~ -<; D "';\ $:>17i:>'" a.." 3 H", ~. (;, rJ c.l f~ ~- ~ 3 ;2: 1"'\ i"- ""<l ~ tv 1Q n ~ ~""""'." ~ m % c-:.:. C:> lj) ~ ." <=> 0 rn 00 0 -I c: n :t '::;.4" c: l> :0 Z ;iI'lI; ,r". .. ('..I) Z -1 ~ m n n 0 ::>:.J f \, rr1 -1m 0 :c > ~ rrl "").._ --u -< 0 :J> m C).... f" C) n (I) 0-::\ rv 0 -rJ c:::::> en ,~ :t ""T1 ~ -'" ...- CO Z 0 t~: :r r'r'] ~ -~ rt" '<~ .:D l> :-:;:J c:::> rn (I 3 r- _Xl :0 () Q l r j;> co c: U.J ~ (fl g: c:::::> ;:><: CJ m l> 3:i \ c::> -.J N Grl CJ) 2: Grl 0 AFFIDAVIT FOR TRANSFER PROPERTY 200808076 /tJ , {() STATE OF NEBRASKA ss: COUNTY OF HALL Comes now RAYMOND L. VANG, being first duly sworn on oath, deposes and states as follows: 1. That Affiant is the surviving spouse of Florence M. Vang who died August 17, 2008, at Grand Island, Nebraska, as shown by the certified copy of the Certificate of Death of Decedent attached hereto as Exhibit "A" and by this reference incorporated herein; Exhibit "All is, a certified copy of the original Certificate of.Death on file with the Department of Health, State of Nebraska. 2. That Florence May Vang and Florence M. Vang are one and the same person despite the discrepancy in her middle name. 3. That Affiant and said Decedent were husband and wife on the date of the Decedent's death on August 17, 2008, and were on said date sole owners as joint tenants not tenants in common, with right of survivorship of the real property legally described as follows: LOT FOUR (4) IN BLOCK ONE (1) IN "La HEIGHTS SUBDIVISION" IN THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER (NW1/4 NW1/4) OF SECTION ELEVEN (11), TOWNSHIP ELEVEN (11) NORTH, RANGE TEN (10) WEST OF THE 6TH P.M., HALL COUNTY, NEBRASKA 4. That by reason of the provisions of the j oint tenancy warranty deed Affiant became the sole owner of the above described property on Decedent's death. 5. That this Affidavit is given as evidence that pursuant to Neb. Rev. Stat. SeC. 77-2003, no inheritance lien arises due to the death of the Decedent nor can the same attach to the above described real estate; that pursuant to Sec. 77-2012, no Nebraska Estate tax or Inheritance tax is due to the State of Nebraska because of the death of the Decedent nor can such tax attach to the above described property. FURTHER AFFIANT SAITH NOT. DATED THIS ~~day of September, 2008. ~.:(~~iant SUBSCRIBED IN MY PRESENCE a day of September, 2008. ,~~. before me this -1~ J;GEItERAl NOTARY. State of NllbfUIr,a 8. J. CUNNINGHAM _ My Comm. Elcp. Aul. 11. 2009