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r 83:;' 005391 r STATE OF NEBRASKA COUNTY OF HALL ss. AFFIDAVIT OF DEATH OF JOINT TENANT Dorothy M. Carson, being first duly sworn on oath, deposes and says that she resides at 1620 North Huston, Grand Island, Nebraska; that her husband, Earle J. Carson, died on August 31, 1983, at the Nebraska Veterans Home 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 computation for determination of Nebraska Inheritance Tax and Federal Estate Tax was property owned by the Decedent 1n joint tenancy with your Affiant, his surviving spouse; that the total value of all such property, as of August 31, 1983, valued at its fair market value on that date, did not equal or approach the sum of $275,000.00; that Affiant 1S en- titled to an exemption in computation of both Nebraska Inheri- tance Tax and Federal Estate Tax of the total value of all such taxable property received by her by reason of the death of the Decedent or otherwise, and that there is no Nebraska Inher- itance Tax nor Federal Estate Tax due or owing by this Affiant by reason of property pass1ng to her upon the death or otherwise of Earle J. Carson on August 31, 1983. t!) -<>//-7",/ ~o''?;1 ~--z....T ':"4-L-4~ /. I ' Dorothy M. ctfrson (~A<:'-o-r/ SUBSCRIBED AND SWORN to before me, A Notary Public, this r day of <f)~ , 1983. 4~'P Q ~ Notary Publ1c ~. GEtilEAAl HOTARV- St.l. d ".1>>..111 DUANE A, BURNS MyC_~_""U.I'" INDEX: Lot One Hundred Twenty (120), in West Lawn, an Addition to the City of Grand Island, Hall County, Nebraska. ~'