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�U1�U3430 <br />4. On the Decedent's date of death the undersigned A�ant was the owner of the <br />above described real property with the Decedent in joint tenancy; atta.ched hereto and <br />incorporated herein by reference there appears a'capy o��t�ie Deceder�t's d�ath o�rtifiea�e: ---- <br />5. More than 30 days have elapsed since the death of the Decedent, and the value of <br />the Decedent's interest in all real property in the Decedent's estate located in this state does not <br />exceed $30,000.00. The value of the Decedent's interest in the above described real property as <br />shown on the assessment roles for the year in which the Decedent died is $��� ���. °� <br />6. No application or petition for appointment of a personal representative is pending <br />or has been �anted in any jurisdi�tion� the uti�er�igned l�ffiant as �urviving joint aE�mer is <br />entitled to the above described real property and no other person has a right to the interest of the <br />Decedent in the described property. <br />7. The undersigned Affiant, as claiming successor, is the son of the Decedent and <br />the value of the entire estate of the Decedent is $ a7S, do 0 <br />Pursuant to Section 77-2037 R.R.S. Nebraska no lien of the Inheritance Tax exists. <br />8. 'The undersigned AfFant as claiming successor affirms that all statements in this <br />Affidavit are true and material and further acknowledges that any false statement may subject the <br />undersigned to penalties relating to perjury. <br />Dated the � day of �� � , 2009. <br />s <br />�.��Y� � <br />Dennis Da.le Stark <br />Subscribed and sworn to before me the � day of � , 2009. <br />� .. - <br />� <br />Notaly PubliC �L NOTARY - State �f Nebraska <br />WILL.tAM A. FRAtVCIS <br />— � My Comm. Exp, pec. 31, 20i 1 <br />