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- �� N � 0 �� � � N �� 0 W � � ..�� � �� w �� �� �� �� STATE OF NEBRASKA COUNTY OF HALL � � � .. r ,;� r� � �V � N d! • g � r � C 3s � � G ��. � ? rn . � � O O � _ r' °` W � � � _ t-a rn � S m � � ' O .� Tl r� r� � � 3 r- � O r ^ �' n, v w p �..� � � n, A n'1 � � '- ,,,,L; �`'' � tn � w � AFFIDAVIT OF MARgTAL STATUS ) ) ss. ) COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Velma J. Kiser Date of Death: July 13, 2001 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Donald D. Kiser Date of Marriage: ��e9�� 0 e.�✓' 1 C j l�o�� 2. The Affiant is related to the Decedent as follows: surviving spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tena.ncy, to-wit: See Attached Exhibit "A" 5. As of the date of death, the real estate has a fair market value of $��, °� �� V�� 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate talc lien by reason of Nebraska Revised Statutes Section 77-2102. FURTI-iER AFFIANT SAITH NOT. SUBSCRIBED and SWORN to be �1:NQTAR°f -St�e�� ' 6�ElWitl py Cdrpq, ptp hdte 28. 261g / �s� Return to: Galen E. Stehlik P 0 Box 400 Grand Island, NE 68802 � �/� ,�,:�� ��i, � � . -