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� <br />�� <br />N � <br />0 �� <br />� � <br />N � <br />� �� <br />0 <br />� �� <br />N -� <br />� <br />� <br />� <br />�� <br />Returu to: <br />Galen E. 5tehlik <br />P O Box 400 <br />Giand Island, NE 68801 <br />STATE OF NEBRASKA <br />,�n���•z���r:r:��� <br />� <br />�! <br />� � <br />� � • <br />� Q� <br />�� <br />� <br />20120072�; <br />S <br />D <br />r <br />r <br />c� <br />o, <br />� � <br />c� <br />� <br />--� <br />rn <br />� <br />0 <br />� <br />o �• <br />rn <br />rn � _ <br />0 <br />� <br />AFFIDAVIT OF MARITAL STATUS <br />) <br />) ss. <br />) <br />�v <br />► <br />•v <br />� <br />� <br />� <br />W <br />O <br />� <br />3 <br />f <br />� <br />W <br />O <br />Ca� --I <br />C � <br />� m <br />� <br />� o <br />O � <br />�' z <br />= m <br />D � <br />r � <br />r n <br />cn <br />� <br />� <br />tii v <br />tn <br />� <br />N <br />O <br />F-+► <br />N <br />O <br />O <br />� <br />N <br />C73 <br />13' <br />Yf <br />� <br />s <br />� <br />i�. <br />� <br />� y s�� <br />�, :J <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Junior H. Radney <br />Date of Death: December 3, 2011 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Tami D. Radney <br />Date of Marriage: May 8, 1990 <br />2. The �ant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska. Inheritance TaJC or Nebraska Estate Tax that is due because <br />of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to-wit: <br />Lot One (1) of Little Subdivision recorded October 20, 2003, as Instrument # <br />200313882, records of Hall County, Nebraska, <br />5. As of the date of death, the real estate has a fair market value of $141,807.00 <br />6. The Decedent and �ant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77-2102. <br />FLJRTI�R AFFIANT SAITH NOT. <br />�� <br />� <br />Tami D. Radney <br />SUBSCRIBED and SWORN to before me this �? day of January, 2012 <br />�1�� <br />�M1IERAL NOTARY - 5tate of Nebraske No Pub1iC <br />JULIE J. SKEEN <br />_ My Comm. Exp. July 19, 2015 <br />