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<br /> 97,.r �04'7�t
<br /> AFFtDAVIT OF MARITAL STATUS �
<br /> STATE QF NEBRASKA )
<br /> )s�.
<br /> COUNTY OF HALL )
<br /> COMES NOW,the w�der�ig�ned,bein8 duly sworn,deposa and says�:hit th�
<br /> randa�aigaed knows the Ikcedent u�d the s�uviving spouse of the Decedcut ra�d thnt the
<br /> fallowing iaformation is mie aad conect:
<br /> 1. N�une of Aecedent: Robat L.Lacy
<br /> Unt�of Death: A:�ge�s� 16,1986
<br /> Doa�icik st D�te of D�at6: Crand Idsnd,Hall Coun�ty,Nebraeka
<br /> Niuno of Survivit�g Spouae: Ann C.I.acy a/lc/a Ann I.,�cy
<br /> z, The A�nt�s�i1i�c�„rith tiae Decedeat aa the attor�y fa the Esate of Robert
<br /> L.L�cy,Pmbatod in the County Court of Hall County,Nebnw�ca, Case No.
<br /> PR86-121.
<br /> 3. Titk to the following deaaibed real est�tr-rvas hdd by the DecedeAt and the
<br /> surviviag spouse of the Decedent in joint ta�ancy u tLe t+me of the Decedent's
<br /> de,ath,tawit:
<br /> Lot Ot�e(1)in Block Te�(lo),in Ashton Place AGaition to tne i:iry oi urand
<br /> Is��d,Hall CouMy,Nebr�slca.
<br /> 4. The Decedait�nci Mn C.Lacy wae m�rried aa of tlx�dste of death. Th�re is ao
<br /> Nebix�ka Ini�iwice Tax lieaa by re,�soe of Nebr�sks�R�.vi�ed Statute� . ,
<br /> Section 77-2003. 'I'her�isno Ndx��ica E�tate Tox liai by reuon of Nebr�;ak� ,
<br /> Reviyed Statutes Section 77-2102.
<br /> F4JRTI�R A��M q�ith not.
<br /> ,
<br /> Arthur C.May�r,Affiant �
<br /> Subscn'bed and swoin to beforo me this '��'day of J 997.
<br /> � {�LMOiMY�11MIMM�Mta �,�j'
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