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I'V S S (Xl S (Xl <0 CJ'l CJ'l ;lID m -n C n Z ,:; ~ ~ ('\<11 1ll;:I: on :1:)> m Ul 0:1: 7l: C:::.:::> 7-:1 ----i r'0 W ~;~~~ c:...--:::,Jo = ("") en C> -. C: l" z -I ...-irrl --<0 Cl -;-'1 --'T1 :z. ::c ro; 1;'- CJ r- ,:0 r- J:;> en :;><; J> ......... 1.1. t""' '.~' (....... " ~~'P ('",1 ,1'1 ('1-' ~), ~,.~.. c> --~ "Tl ~(J, l-:J '); ~ ~, ~~,J ~ Ul r (- C) '^' () -u ::3 ~ ---- ---- G.) Ul c.n en 200808955 AFFIDAVIT STATE OF NEBRASKA so' . ~ . COUNTY OF HALL Affiant, CAROLE M. ESSINK, after being first duly sworn on oath, deposes and states as follows: 1. That Affiant is the surviving spouse of Jimmie L. Essink, who died September I, 2008, as shown by the certified copy of the Decedent's death certificate attached hereto as Exhibit "A" and by this reference incorporated hereinj that Exhibit "A" is a certified copy of the original Certificate of Death on file with the Bureau of vi tal Statistics, Department of Health, State of Nebraska. 2. That Affiant and the said Decedent were husband and wife on the date of the Decedent's death on September I, 2008, and were on said date the sole owners as joint tenants not tenants in common, of the real estate legally described as follows: LOT THIRTEEN (13) IN HUSMAN'S SUBDIVISION AN ADDITION TO THE CITY OF GRAND ISLAND, HALL COUNTY, NEBRASKA 3. That by reason of the provisions of the Joint Tenancy Warranty Deed, Affiant became the sole owner of the above described property on Decedent's death. 4. That this Affidavit is given as evidence that pursuant to Neb.Rev.Stat. Section 77-2003, no inheritance tax lien arising due to the death of the Decedent can attach to the above described real estate and that pursuant to Neb.Rev.Stat. Section 77-2012, no Nebraska estate tax lien arising due to the death of the Decedent can attach to the above described property. FURTHER AFFIANT SAITH NOT. Dated (!)d. ~ ^ , 2008. f j;W~ I7J, t~ CAROLE M. ESSINK, Affiant SUB~R,Jl?ED in day of ~\~ my presence , 2008. RGT T() : PREPARED BY: John M. Cunningham #17276 CUNNINGHAM, BLACKBURN, FRANCIS, BROCK & CUNNINGHAM, Attorneys 222 North Cedar Street P. O. Box 2280 Grand Island, NE 68802 7.1.... _.~;- .""..;> . m o~ m :IJ m o );:0 U) Z U) -I :0 c: s: n1 :z Ul-l z '0 f',) C) C) co o co CD Ul C:'-,.)\J:.- o