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I 83- 005324 r I STATE OF NEBRASKA AFFIDAVIT OF- DEATH OF JOINT TENANT ss. COUNTY OF HALL Helen M. Seymour, being first duly sworn on her oath, deposes and says that she resides at 923 North Wheeler, Grand Is- land, Hall County, Nebraska; that her husband, William A. Seymour, died September 3, 1983, in Grand Island, Hall County, Nebraska; that a copy of his Certificate of Death is attached hereto as Exhibit "A"; that her husband left no property separately owned by him and that all property subject to consideration and compu- tation for determination of any Nebraska Inheritance Tax and Fed- eral Estate Tax was property owned by the Decedent in joint ten- aney with your Affiant, his surviving spouse; that the total value of all such property, as of September 3, 1983, valued at its fair market value on that date, did not equal or approach the sum of $275,000.00; that Affiant is entitled to an exemption in computation of either Nebraska Inheritance Tax and Federal Estate Tax of the total value of all such taxable property re- ceived by her bv reason 01 the death of the Decedent or other- wise, and that there is no Nebraska Inheritance Tax nor Federal Estate Tax due or oWing by this Affiant by reason of property passing to her upon the death of William A. Seymour on September 3, 1983. Real estate owned by the parties In joint tenancy is described as follows: Lot Five (5) in Block Fifteen (15) in Russell Wheeler's Addition to the City of Grand Island, Hall County, Nebraska. kL~;'H'e l:~~~) M .'~itey~~J~ ~''-<-L SUBSCRIBED AND SWORN to before me, A Notary Public, this 4th day of October, 1983, L J.;"".IW.. 1lIf...IY..-St............It.'.. DUNtl '" WIllIS ....-....-.,- ,,/J " I /~r:? ~<~4'-(' C;: 1._2_<,,(/~~. Notary -'Publ ic "- \.