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~~~ ~ ~ <br />m = <br />O (~ ~ <br />m <br />~ ~- ~ <br />~ r" ~ ~ `,~ tV c~ Tt G7 "S',J <br />~ ~ T rr t CL7 ~ <br />`°' -x-9 <br />~ ~ ~ ~ ~ ~ r~*i ~~ -~ A m C~ <br />p~ ~ ~ ~7~~ ~ ~ ~ ~:~ <br />~ ~ AFFIDAVIT ~ rv n w <br />ITATE OF NEBRASKA ) rv ~ ~ p <br />_.._ <br />ss: <br />COUNTY OF HALL ) <br />Affiant, FLORENE SKEELS, after being first duly sworn an <br />oath, deposes and states as follows: <br />1. That Affiant is the surviving spouse of Keith M. Skeels, <br />who died October 20, 2009, as shown by the true copy of the <br />original record on file of Decedent's death certificate attached <br />hereto as Exhibit "A" and by this reference incorporated herein; <br />that Exhibit "A" is a certified true copy of the original <br />Certificate of Death on file with the Bureau of Vital Statistics, <br />Department of Health, State of Nebraska. <br />2. That Affiant and the said Decedent were husband and wife <br />on the date of the Decedent's death an October 20, 2009, and were <br />on said date the sole owners as joint tenants not tenants in <br />common, of the following described real property: <br />LOT SEVENTEEN (17), BLOCK TWO (2) PARKHILL SUBDIVISION <br />AN ADDITION TO THE CITY OE GRAND ISLAND, HALL COUNTY, <br />NEBRASKA, known as 2524 W. Anna Street, Grand Island, Nebraska <br />3. That by reason of the provisions of the Joint Tenancy <br />Warranty Deed, Affiant became the sole owner of the above <br />described property on Decedent's death. <br />4. That this Affidavit is given as evidence that pursuant to <br />Neb.Rev.Stat. Section 77-2003, no Inheritance Tax lien arising due <br />to the death of the Decedent can attach to the above described <br />real estate and that pursuant to Neb.Rev.Stat. Section 77-2012, no <br />Estate Tax lien arising due to the death of the Decedent can <br />attach to the above described property, and that said described <br />real property passed to Affiant as surviving joint tenant, free <br />and clear of Nebraska Inheritance Tax. <br />FURTHER AFFIANT SAITH NOT. <br />Dated: November ~_, 2009. <br />SKEELS, Affiant <br />SUBSCRIBED in my presence and swar <br />day of November, 2009. <br />~iAl' NOTIIFIY ~ ~ of Nebr N tar u <br />B. J. GUHMgNC~liAM <br />Cogwq. Ems. .11, 20f8 <br />PREPARED BY: <br />B. J. Cunningham, #10865 <br />GUNNINGHAM, BLACKBURN, FRANCIS, <br />BROOK & GUNNINGHAM, Attorneys <br />222 North Cedar Street, P. O. Box 2280 <br />Grand Island, NE 68802 <br />(308) 389-2636 <br />a before me <br />~c <br />5 <br />