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i� ~ a � T D <br /> � �� v S � 7�C 3' <br /> \ ��y'� 1'il (,� � <br /> � � � � V� <br />' � V � CO 'C� �/1 <br /> O� O --i <br /> (� � '� -'�O � � M� � <br /> y, :1 � "� w .-r <br /> �,�� � � -< � ' CD <br /> --s <br /> � � `J� Q7 � � H r'.3. <br /> � 1� \ <br /> � ' � i"1 N <br /> � � T► Em O <br /> \` . '1 � r A W C/f <br /> � `` 7 � � � <br /> � � n � ~ � ~ � <br /> �--� �"� � N <br /> 1 .T � LQ � <br /> � AFFIDAVIT z <br /> 0 <br /> � � STATE OF NEBRASKA ) <br /> � ) ss. <br /> COUNTY OF HALI, ) <br /> Affiant, MILDRED DIBBERN, after being first duly sworn on o <br /> oath, deposes and states as follows: �G <br /> l . That Affiant is the surviving spouse of ELMER FREDERICK <br /> DIBBERN, who died February 16, 1998, as shown by the certified copy <br /> of the Decedent' s death certificate attached hereto as Exhibit "A" <br /> and by this reference incorporated herein; that Exhibit "A" is a <br /> certified copy of the original Certificate of Death on file with <br /> the Bureau of Vital Statistics, Department of Health, State of <br /> Nebraska. <br /> 2 . That Affiant and the said Decedent were husband and wife <br /> on the date of the Decedent' s death on February 16, 1998, and were <br /> on said date the sole owners as joint tenants not tenants in <br /> common, of the real estate legally described as follows : <br /> A• Lot Three (3) , Block Four (4) , South Grand Island <br /> Addition to the City of Grand Island, Hall County, <br /> Nebraska; <br /> and <br /> B• The West Half of the Southeast Quarter <br /> Section Fourteen (14) , Township Ten (10) No th/ R nge/Ten <br /> (10) West of the 6th P.M. , Hall Coun ty, Nebraska. <br /> 3 . That by reason of the provisions of the Joint Tenancy <br /> Warranty Deed, Affiant became the sole owner of the above described <br /> 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 real <br /> estate and that pursuant to Neb.Rev.Stat . section 77-2012, no <br /> Nebraska estate tax lien arising due to the death of the Decedent <br /> can attach to the above described property. <br /> FURTHER AFFIANT SAYETH NOT. , <br /> Dated 1998 . <br /> , <br /> �����P�Vt�� <br /> MILDRED DIBBERN <br /> SUBS RIBED in my presence and sworn to before me this _� <br /> day of ,�. , , 1998 . ` <br /> ��� GEHERAL NOIARP•State ot Nebr�ska � G�_,�� <br /> REGINA R.OLSEN � <br /> MyComm.Exp.Oct 27,�99g Nota Pub1iC <br />