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<br />00446!J
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<br />STATE OF NEBRASKA
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<br />ss,
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<br />AFFIDA VI'f
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<br />COUNTY OF HALL
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<br />DOROTHEA BRUNHOLTZ, also known and one in the same as
<br />DORA BRUNHOLTZ, being first duly sworn on her oath, detDDBes and
<br />says that she resides at Cairo, Hall County, Nebraska; that
<br />she is the widow of Rudolph H. Brunholtz who died on the 8th
<br />day of August, 1984, and who was a resident of Cairo, Hall
<br />County, Nebraska, That her husband was one in the same as
<br />Rudolf Brunholtz,
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<br />Tha t no proceed i ngs for proba te of the Las t Wi 11 and
<br />Testament and Codicil Lhereto of Rudolph H, Brunholtz has been
<br />commenced and none is contemplated; that the only real estate
<br />in which decpdent ownpd any interest was owned by him in joint
<br />tenancy with your Affiant, his surviving spouse, Such jointly-
<br />owned real estate is described as follows:
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<br />Lots Five (5) and Six (6) in Block Four-
<br />teen (14), in the Original To~ n or Cairo,
<br />Hall County, Nebraska.
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<br />The decedent owned an i.nterest in personal property, the
<br />great bulk of which was uwned in joint tenancy by him with his
<br />widow, this Affiont_ Apparently there is a passbook savings
<br />account with the Slate Bank ot Cairo, Cairo, Nebraska, in the
<br />amount of $3.u86,]5. By the provisions of the Will of rhe
<br />d.'cedenL, il this A.ffiant survives her husband by 30 days, all
<br />separately-owned 3ssets, including such passbook savings
<br />accounl, arp giVf~ll t(} tler.
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<br />l'hv d('c,,-'Jl~nt It:,ft him SUlvlving a~ hi::; sole heirs-at-law
<br />and the mllY persons ]!!teresle'd in this estate', the following:
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<br />DQrothea Brunhl.>ltz, his widow;
<br />Emma Powell Slick, step-daugllter;
<br />Ce~ili~ Belk, daughter;
<br />Wiiil~lmina ~Jayb~e, daughter;
<br />Hargut:>r! t~i Ll...itlg, daugbt.f'r;
<br />JOhll Brlloill1ltz, son;
<br />Rudolph B!'unl101tz~ Jr.; sun; and
<br />DUnl1d Vogel, daught~r.
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<br />rh!~ A1 i lHnt r't'i..~t:\lVt:':::i ,:.111 a&$t'lti uf this ('state and as
<br />Uh' survlvulg "puus,," cd tht~ decedenl, all such assets are exempt
<br />undel thl~ Nebr-aska Inh,'l'iUlllC,e Tax law:;, The Loud gross value
<br />.o! all taxable ilSSt'ls ,'I ,he decedent lor Federal Estate Tax
<br />puqwses is fal it'ss thiW $325,1)00. NQ r'ederal Estate Tax Return
<br />lS required and all such taxablE' assets passed to his surviving
<br />spouse 3nd are ~x~nlpt [ruin Federal Estate 'fax.
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<br />D~roth~a' Brl.lnhQlt~
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<br />Subscribt:d ::1nd SWI...)I"l1 tlo..' Dl;,;'l{\re !lie t.he datt_~ last above
<br />Wl'ltLen. '\
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