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<br /> ��'� `� `.�k� Decedent� �d t�tat the followiag infozmation is true and correc :
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<br /> :.����,f. ,..` �. Name of Decedent: Stevea Ray Antle
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<br /> �� � g ' Date of Death: Marcb 9. 1998 .
<br /> �' ;, - , �-:° =a`: - . han• FIalI County N?braska
<br /> .�.;� r,.''•:�� : " . ;�,:� Damici�e at Date�of. Death. Dcnip .
<br />,;,;, ; "'�'� "'� viv3.ng �SP�;Y Barb Aatle
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<br /> ,,�. �s��,- � Date of Marriageq : �O�fiober 12, 19T� . .. �
<br /> :� .�,�°. z. The l�fiant is:>.��lated to th�°'��ecedent as follows: the
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<br /> F'�;���� � ��� '�'�� , � +, Tax N8�3T$S�:`.,�heritance Tax or
<br /> � ' .�'t��;� 3. There is �ao Fed,�s,��I;:�,.�,'"�.�,,���4 •�, . -;,�,
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<br /> ' ' ��� �.•.i�,�,hFas1{a Estate Tax fiY�a� ��rose� . or ca� aYise.. bY ,
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<br /> ' { ��^��- =�=° �� 4`, Ti�le to�the following c������ed real estate was held by the. . _
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<br /> .f``,�Y;r:...:: �; Deceden�:=�ad Harb Antleo�''t�� •�ecedent s �ouse, on the ,�ate .of the
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<br /> .,'` �` - . � �test Heights Additicn, ���ud,d. ��1and, '��� �+'���, ,
<br /> _ •rh�: s�.: Lot�Fifty 1���,a.; � . �:.� . ,
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<br /> ,..-. , �,�.��' . . � e r'��1 estate has �c���air market �{l�<.�
<br /> � . , 5. As� of the date��of death, th
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<br /> ' -•- . �,:.:.,�. - ��alue of $32.375:00. . � ,. .
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<br />- ;..;A�;;�::_��: � �. The Decedent and Barb Antle were married as of the da���:�f ,
<br /> . ; • death of Stenen Ray Ant1e. There is no H�,raska Inheritance Tax I;ie�, ,1,...
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<br /> .,�. {� �. �and no Nebraeka,'���►tate t� lien. ���,���'
<br /> ... ,�°�Yr'�!'�'' = AI�1D FURR'HL�Fi���•.�F'FIANT SAITH NOT. � . .
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