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989900Z0Z <br />Cr) <br />Cr <br />Return to: <br />GLO <br />1% 1228 L Street <br />Aurora, NE 68818 <br />AFFIDAVIT AND DEATH CERTIFICATE <br />STATE OF NEBRASKA <br />ss. <br />COUNTY OF HAMILTON <br />ry <br />f-..; <br />C) <br />_r_ <br />Co <br />Affiant, Joseph F. Liess, after being duly sworn upon oath, does depose and state as <br />follows: <br />1. That Affiant is the surviving spouse of Loraine A. Liess, deceased, who departed this <br />life on April 12, 2020, as shown by the certified copy of the death certificate attached hereto and <br />by this reference incorporated herein. <br />2. That on the date of death, the Affiant and decedent were the sole owners as joint <br />tenants with right of survivorship of that real estate legally described as follows: <br />The North Twenty One Feet (21') of Lot One (1) and the South Forty One Feet <br />(41') of Lot Two (2), Block Sixteen (16), in West View Addition to the City of <br />Grand Island, Nebraska, in Hall County, Nebraska. <br />3. That by virtue of the survivorship of Affiant. Affiant became the sole owner of the <br />above-described property. <br />4. That this Affidavit is given as evidence that pursuant to Neb. Rev. Stat. §§77-2003 <br />and 77-2004, the above described real estate is not subject to Nebraska Inheritance Tax and, as <br />property passing from decedent to his spouse, said property is not subject to any lien for <br />Nebraska Inheritance Tax. <br />5. That the gross estate of decedent was less than the amount exempt from federal estate <br />taxes for the year 2020. <br />FURTHER AFFFIIANT SAYETH NOT. <br />Dated this '. day o ma; 20. <br />se h h F <br />p <br />SUBSCRIBED AND SWORN to before me thisd3 —. day of <br />, 2020. <br />Notary Public <br />rn <br />—1 <br />rn <br />rn <br />N C7 <br />CJ n <br />C7 Z <br />O <br />Ul <br />C7) g <br />Cb Z <br />CJ1 <br />