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.~` ~' o ~ ~- ~ ~ ~ ~' ~ ~~ X~ ~ n ~ ~ ~~ rv ~ ~~~ ~~ ~ can ca~ ~ °„ ~ ~ AFFIDAVIT OF DEATH STATE OF NEBRASKA ) ss. COUNTY OF FURNAS ) James H. Dodson, being first duly sworn upon oath, deposes ~ ~ and states as follows: 1. I am an attorney (Neb. Bar Association #15651) residing in Furness County, Nebraska and am a partner in the law firm of Dodson & Dodson. 2. On October 2, 2003, Robert A. Hansen & Nancy Hansen, husband and wife, executed a Joint Tenancy Warranty Deed. wherein they made Donald D. Lacey, a joint tenant with rights of survivorship in and to the realty described in the Attachment to this affidavit. Said deed was recorded on January 9, 2004, as Instrument No. 02.00400249 :iri 1-.he Deed Records of Hall County, Nebraska. 3. Thereafter, Robert A. Hansen and Nancy A. Hansen entered into an agreement to purchase the interest of Donald D. Zacey, a/k/a Donald D. Lacy, in and to the realty described in the Attachment to this affidavit. A Notice of Real estate Agreement was recorded on March 6, 2007 as Instrument No. 0200701709 in the Deed Records of '-fall County, Nebraska. 4. The law firm of Dodson & Dodson was named as escrow ages'"~ to receive all payments under the contract and to dis~.~~ibute .;aid payments to Donald D. Lacey. 5. Donald D. Tracey, ,a/k/a Donald D. Lacy, died on November 17, 2009. A ce.rtif.ied copy of the death certificate is at}achFd to this affidavit. 6. Thirty days have elapsed since the death of the Decederi t . 7. On the date of Donald D. Lacey's death, he was the legal tit1F~ owner of a joint tenancy with survivorship interest ir~~ the .realty described in the Attachment to this affidavit. S. The va.L~_ie of the decedent's interest in all real propezt.y in the decedent's estate located in the State of Nebraska does not exceed $30,000.00 as reflected by the r~:~rr~aini.ng balance due under the contract for purchas~~~ of tkae Decedent' s interest in the said realty. 9. The entire Nebraska estate of Donald D. Lacey, Deceased, wherever located, less liens and encumbrances, which would be subject to probate prcr_•eedings does not exceed $30,000.00.