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� — N � B = � � 0 � -p � � � � - � � � r�ee q � d ! � �� � � Return to: CUNNINGHAM, BLACKBURN, FRANCIS BROCK & CUNNINGHAM 222 N. Cedar St. Grand Island, NE 68802 Affidavit � :, ,:P``. i *. : AFFIDAVIT � � .--� �, «._,. � �j T� � � r e r �-� r �' � r. , G �� � �. � C� rr � r - � , _. v, � r%� � �:i �� O 1 Ti O rn : N m Cr �j O �.— c� tn o -� C m z � m � � O � � �r S rn D c� � � � D !l� � n � CJ) COMES NOW, the undersigned Affiant and being first duly sworn upon oath deposes and states as follows: 1. Name of Decedent: Mary Ellen Rupp; Date of Death: July 14, 2011; Domicile at Death: 2822 Lakewood Circle, Grand Island, NE 68801; Name of Surviving Spouse: Robert W. Rupp. 2. The undersigned �ant is the husband of the Decedent, Mary Ellen Rupp and is the surviving joint owner of the real estate legally described as: Lot Seven (7), Unit Thirteen (13), Oakwood Condominiums af Brentwood Fourth 5ubdivision, Grand Island, Hall County, Nebraska. 3. Attached hereto as Exhibit A incorporated herein by reference there appears a Certified Copy of the Decedent's Death Certificate. 4. There is no Nebraska Inheritance Tax Lien by reason of Nebraska Revised Statute, Section 77-2033; and no Nebraska Estate Tax by reason of Nebraska Revised Statute, Section 77-2102. 5. As of the date of death of the Decedent, the real estate described above had a fair market value of $186,000.00. FLJRTI�R �ant sayeth not. obert W. Rupp, Affiant 5UBSCRIBED and sworn to before me the ��day of August, 2011. Y Notary Pub GENE'RAL NOTAflY - State �f Webraska WILLIAkA A. FRANCIS My CAmm. Exp. Dec. 31, 2011 O N O H� �� O C7� �� u� m Y` �. ieu � 1 y, � 5� �G�'