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<br />STATE OF NEBRASKA ) <br />ss. AFFIDAVIT <br />COUNTY OF HALL ) OF DEATH AND AS TO ESTATE OF <br />HENRY H. WASHINGTON, SR. <br />Flora LaJoy Washington, being first duly sworn on her <br />oath, deposes and says, that she resides at 1104 East Fourth <br />Street, in Grand Island, Hall County, Nebraska. That she is <br />the widow of Henry H. Washington, Sr., wha died an the seventh <br />day of March, 1984 in Grand Island and who was also a resident <br />at the above address. <br />Henry tt. Washington, Sr. died testate, but his Will has <br />na[ been offered for probate; and if. is not contemplated that <br />it will be probated. Afl assets owned by the Decedent at the <br />time of his death were c?weed by him i.n _}aint tenancy with this <br />Affiant as the s~crviving taint tenant. <br />The Decedent had owned premises described as follows: <br />Lot. Sis (6} in Pyiock Twelve {12) in <br />Evans Addition to the City of Grand <br />Island, Hali ;::aunty, Nebraska, com- <br />monly (mown as /I~I04 East Fourth <br />`itrer'.t k;l sidi.d laity. <br />On September Ib, Iz?8l, the Decedent made, executad and delivered <br />r~ WarrancE• 1)~:<~d ~.,nvc•,rins said premises to Flora i.a.Ioy Washing- <br />ton, thi> t[2iant„ reterviny~ tc~ the Decedent a life estate therein <br />far his benefit and during t:he rarnainder of his lifetime. Such <br />heed was delivered to 'r'It~ra t,a3c+y Washington on September 16, <br />I9Sl, and szas been in her z}ossession and control at all tifftes <br />..since that date. <br />'Ihe Decedent left. him surviving as his sole heirs at law <br />the following: Flora i.a.loy Washington, hit; widow; Judy Mitchell, <br />daughter a,~, prior marriage; .7aync Washington, daughter, Henry <br />}I. Washington, Jr,, son; and _~acquelyn Washington, daughter. <br />The total value of taxable assets for Federal Estate <br />Tao computation purposes waald be :far less than $325,000, all <br />such taxable property passed to this Affiant, his surviving <br />spouse; €ind there i.s no, "r"ederal Estate Tax Return required to <br />be filed and ne such tax nor any Nebraska InheriCanee Tax due <br />or owing herein- <br />DATI:D .his 14th day of March, 19$4. <br />;~ _ <br />FLORA t.~~J Y W' SHIN ,T N-,.. _ <br />SLBSLRIBIU and sworn t.o hetore roe this loth day of March, <br />lt?84, ley Notarial {.'c,mmissic>n expire s.: _'-f.--~~3. <br />~~~~~~ <br />