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O~~ jIID n 9 m ~ t'........, m ~ \> ~ "'11 Ci'l t,.":"....~.:.) ("") (fJ 0 ~ c: ~ :I: = 0-1 ~......., n z ~ "'\~ c:x;.. N 'V' ~ :E: no ;'~." ~,'.' en Z-1 :0 >~ :::0 ~" on -1m <::) m ~)X ~ m f"Tl ".~. -0 -<0 C"J n en C') ?-" N ~ :c '-.... f'- r'V 0>1 c:::> tn s ~~~ <:) ~. ....c "Ilz co S -,-, 0:> ~C~ C".J tJ 3: 1"1"\ Z S :x;.. OJ c:::> ~ r'l tl =:0 0:> ~ ~ ':i Pl ::3 r" ?J co ....... f c' e r J> :xJ ~ ~ ~ c.n ........ tn ........ c: N ~ ~ ;><: s: ~ t- :Po- ....c rl1 ........ ................ ~ ~ co (J) N (Jl :z ~ 200808142 0 Sl.." AFFIDAVIT FOR TRANSFER OF REAL PROPERTY WITHOUT PROBATE UNDER NEBRASKA PROBATE CODE STATE OF NEBRASKA ) ) ss. ) ill)/) COUNTY OF HALL The undersigned Affiant, upon first being duly sworn, does hereby depose and state: 1. The value of the Decedent's, Chinda Keolavone, interest in all real estate located in this State, does not exceed $25,000.00 as one-half (12) interest of the assessed value property later described herein totals $35,144.50, with an encumbrance of$28,750.00 and the value ofthe entire estate, less liens and encumbrances, does not exceed $25,000.00. 2. Thirty (30) days have elapsed since the death of the Decedent, Chinda Keolavone, as shown in a certified copy ofthe Decedent's death certificate attached to this Affidavit. 3. No application or petition for the appointment of a Personal Representative is pending or has been granted in any jurisdiction. 4. Affiant is entitled to the real property by reason of intestate succession as Affiant is the spouse of the Decedent pursuant to Nebraska Probate Code Section 30-24,129, and that Affiant's entitlement is based upon Atliant's status as surviving spouse of the Decedent under the provisions of the Nebraska Probate Code Section 30-2303. 5. Affiant has made an investigation and has been unable to locate any Will of Decedent. 6. No other person has a right to the interest of the Decedent in the following described property: Fractional Lot Nine (9), of Fractional Block Six (6), in Wallich's Addition and its complement to-wit: Fractional Lot Nine (9), of Fractional Block Twenty One (21), in Fairview Park Addition, both being additions to the City of Grand Island, Hall County, Nebraska. 7. Affiant swears and affirms that all statements in this Affidavit are true and material and further acknowledges that any false statement may subject Affiant to penalties relating to perjury under Section 28-915. 8. Pursuant to Nebraska Probate Code Section 30-24,130, the successor named in the Affidavit has the same protection as a Distributlte who has received a Dtied of Distribution from a Personal Representative as provided in Se IOn 30-24,10 STA TE OF NEBRASKA ) ) ss. COUNTY OF HALL ) On this ~y of September 2008, before me, the undersigned Notary Public, duly qualified in and for said county and state, personally came Kesavanh K. Keopanya, and acknowledged the execution of the fore ing inst~J1 t!:p be her voluntary act and deed. l' . / (f" Ii:irt,~ , ~ I G!"I!"AL'l-= \'" ... '''= ~tfO:Aa}~~! ~~,~ "...:."".' KARLA J. ARNffi MY COMMISSION EXPIRES October 1, 2011