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r g3-uu6157 r STATE OF NEBRASKA COUr-TY OF HALL ss. AFFIDAVIT AS TO DEATH AND NON-LIABrLITY FOR PAYMENT OF ANY DEATH TAxES ELVERA J. McCARTNEY, being first duly sworn on her oath, deposes, says and certifies as follows: 1. That she resides at 328 South Pine Street in Grand Island, Hall County, Nebraska, and is the widow of Floyd W. McCartney who died intestate on November 8, 1983, and was also a resident of Hall County, Nebraska, at the time of his death. 2. No proceedings for appointment of a personal represen- tative has been commenced and none is contemplated. The decedent owned no separately-owned property. 3. All property subject to taxation for Nebraska Inheri- tance Tax purposes or Federal Estate Tax purposes was property owned in joint tenancy by the decedent with Elvera J. McCartney, his widow and your Affiant. The total value of such jointly owned property did not exceed $150,000.00. No Federal Estate Tax Return is required and there is no Federal Estate Tax nor Nebraska Inheritance Tax due or owing herein. 4. At the time of the death of Floyd W. McCartney, he and this Affiant were the owners of the following described real estate: The Southerly 58.5 feet of the Easterly 91.9 feet of Block Five (5), in Hann's Third Addition to the City of Grand Island, Hall Co~nty, Nebraska, co~nonly known as 328 South Pine Street in said City; said premises had a fair market va lue as of November 8, 1983, in the amount of $42,000.00. 5. No gifts or transfer for less than full and adequate consideration were made by the decedent within three (3) years prior to the date of his death. DATED this ;~ day of November, 1983. C~J;-t.--..<:>Lt:L_- -;. ::. iil-, :?r;~_{ J ELVERA .J. McCARTNEY)' Subscribed in my presence and sworn last above written. My commission expires: February 4, 1984. J;. _..OiAaY-S11t."....nka ARTHUR C. MAYER M,eonw.e..,._4.1984 the da te