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<br /> COI�[EB NOW, thw W�tdrucsiga�d, Io��q duly sworn, d�epoia�� �nd aays.
<br /> that t?ns und�raignad knows thm Dvc�ncl�nt and tih� ourviv�ng �pous� ot �
<br /> t.h� D�aadetit �nd that the foilawin� �.nlormation ie txue and
<br /> __ . ' aorraats �
<br /> i. Neme of Deaede�tt: Libbis Evelyn Ch�lupa
<br /> Da�e of Death: May 21, 1994
<br /> �..—T
<br /> Doaiaila at Date of Death: Ha11 Ccunty, Nebraekr.�a
<br /> Name of Survivinq Spouse: Frank L. Chalt�pa �
<br /> Date of Marriages Augutst 2S, 1942
<br /> 2. The Affiant is related to ttie Deaedent as follows:
<br /> - survivi�+g spouse.
<br /> 3. There is no FederaY BBtate Tax, Nebraska Inheritanae Tax
<br /> or Nebraaka Estate Tax.
<br /> 4. Title to the followinq desaribed real estate .f� 2ield by
<br /> • - - • • �i8 �?eCBdL°!2t 8Ad t2l9 9132^�!�Yi�e� g����tg e�f t�4c3 AeaedB.11t �Ti �o3.ri�
<br />- - ° tonancy, to-wit:
<br /> - — , •� Lot 20, Biaak D in Parkview suk�division located
<br /> ----- in Grand island, Hall Courity, Nebraska. �
<br /> � � 5. As of the date of death, the real estate has a fair marlset `
<br /> value og $80,4y8.00. -_
<br /> ;:�.
<br /> — � 6. �The Deaedent and Affiant were married ae of date of death.
<br /> _ a__:
<br /> — There is na Nebraska Znheritanae Tax lien by reasam of Nebraska w_w
<br /> Revised Statutea Seation 77-2003. There is rio Neb�aska estate tax ' "'
<br /> ��` --
<br /> lien by reason of Nebraska Revised 8tatutes section 77-2102. i-����
<br />-: FUItTHER AFFIANT 3AITH NOT. ���� ,
<br /> ��
<br />�_��sh:��� d --_
<br /> Frank L. Chalupa __.
<br />_- — Subsaribed at�d sworn to before me this �D day of June,
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