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<br />83_006107 <br /> <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br /> <br />ss. <br /> <br />AFFIDAVIT AS TO DEATH AND <br />INHERITANCE TAx <br /> <br />DONNA L. ANDERSON, being first duly sworn on oath, deposes <br />and states as follows: <br /> <br />1. She resides at 907 Sun Valley Drive, Grand Island, <br />Nebraska, and is the surviving widow of Don L. Anderson, who <br />died intestate and a resident of Grand Island, Hall County, <br />Nebraska, on the 17th day of September, 1983. He left him <br />surviving as his sole heirs-at-1aw, the following: Donna L. <br />Anderson , surviving spouse; and three surviving children, <br />Steven D. Anderson, Brenda L. Anderson and Linda L. Anderson. <br /> <br />2. The only property subject to consideration for Nebraska <br />Inheritance Tax purposes in this estate was property owned in <br />joint tenancy by the decedent with his surviving spouse, Donna L. <br />Anderson. As such, all of that jointly owned property was exempt <br />from taxability for Nebraska Inheritance Tax purposes and F~deral <br />Estate Tax purposes. The total net value of such jointly owned <br />property, after deducting the unpaid mortgage on their home <br />premises, hereinafter described, did not exceed $70,000.00. No <br />Federal Estate Tax Return is required in this estate. There is <br />no Nebraska Inheritance and Nebraska Estate Tax nor Federal <br />Estate Tax payable herein. <br /> <br />3. The decedent was a joint tenant owner with his spouse, <br />Donna L. Anderson, of the following described real estate: <br /> <br />The southerly 16 Feet of Lot One (1) and all <br />of Lot Two (2), all in Block Two (2), in <br />Pleasantview Fourth Addition to the City of <br />Grand Island, Hall County, Nebraska. <br /> <br />Said real estate was encumbered by a first real estate mortgage <br />in favor of Home Federal Savings and Loan Assocaition of Grand <br />Island, Nebraska, and which mortgage had, on the date of the <br />decedent's death, an unpaid principal balance of $15,805.00. <br /> <br />4. No gifts or transfers for less than full and adequate <br />consideration were made by the decedent within three (3) years <br />prior to the date of his death. <br /> <br />DATED this 14th day of November, 1983. <br /> <br />,..,xl / (~!; ,,/t'.,.' "';'::') ( <br />~;riONNA L. ANDERSON <br /> <br />Subscribed in my presence and sworn to the date <br />last above written. <br /> <br /> <br />My notarial comm1SS1on expires: <br /> <br />~_dl'" - SlIt- tl..lttj$~ <br />X. ... .. AluH,. ... \JR. c.w.YE.1l <br />.. .. ...~.bo.fob...,1!ll4 <br />. - ~ <br /> <br />