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<br />r <br /> <br />83-005246 <br /> <br />r <br /> <br />'- <br /> <br /> <br />STATE OFN&BRASKA <br />COUNTY OF HALL <br /> <br />ss. <br /> <br />AFFIDAVIT OF DEATH <br />OF JOINT TENANT <br /> <br />Raymond M. Dibbern, being first duly sworn on his <br />oath, deposes and says that he resides at 308 South Cleburn, <br />Grand Island, Nebraska; that his wife, Olga D. Dibbern, died <br /> <br />September <br /> <br />9, 1983, in Grand Island, Hall County, Nebraska; <br /> <br />that his wife left no property separately owned by her, and <br />that all property subject to consideration and computation for <br />determination of any Nebraska Inheritance Tax and Federal Estate <br />Tax was property owned by the Decedent in joint tenancy with your <br />Affiant, her surviving spouse; that the total value of all <br /> <br />property as of September <br /> <br />9, 1983, valued at its fair market <br /> <br />value on that date did not equal or approach the sum of $275,000; <br />that Affiant is entitled to an exemption in computation of either <br />Nebraska Inheritance Tax and Federal Estate Tax of the total <br /> <br />value of all such taxable property received by him by reason of <br />the death of the decedent or otherwise, and that there is no <br />Nebraska Inheritance Tax or Federal Estate Tax due or owing by <br />this Affiant by reason of the property passing to him upon the <br />death of Olga D. Dibbern. A copy of her Death Certificate is <br /> <br />attached hereto as Exhibit "A." <br /> <br /> <br />"-', . .-'- <br /> <br />(-1i~}1!1~J ?p. f//~~ <br />v,,. a mon M. Dlbbern <br /> <br />Subscribed and sworn to before me, a Notary Public, <br /> <br />this ~ <br /> <br />day of September, 1983. ~ <br /> <br />~~"e Q ~ <br />Notary Public <br /> <br /> <br />.* HII. lAA<.ir~'-..I'.............. <br />0UANfi A. BUIlHll <br />M\'''''-u,. ..-.,,. <br />