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� <br />.�� <br />�� <br />�� <br />fV � <br />0 �� <br />0 <br />w �� <br />� _� <br />O�o <br />�� <br />�� <br />�� <br />�� <br />� <br />� <br />G <br />� <br />9 " <br />r� <br />�� <br />��� <br />� � <br />� � <br />�G � <br />X'�� <br />�� � <br />� �° � <br />� � � <br />� <br />G <br />= n � <br />� � � <br />� _ <br />r�, <br />;_= C") (n <br />"�� O --I <br />D � C D N <br />Afl r -r- �, � Z rn <br />;� ]� c-, 4 p-. -c � � � O <br />g�� o �, <br />� � � �__ o - n F—� <br />n' `° W T z N <br />n � S rn � <br />� D w c� � <br />'�' r � <br />�' � r n w � <br />� � � <br />-°� �L~ � � <br />r� � fV � � 0 � <br />v � cn Op <br />� � <br />� <br />Return To: Watson & Ryan, PLC, 535 W. Broadway, Suite 200, CB, IA 51503, (712) 322-0448 <br />Preparer: Watson & Ryan, PLC, 535 W. Broadway, Suite 200, CB, IA 51503, (712) 322-0448 <br />Taxpayer: Donald L Hadenfeldt, P.O. Box 607, Cairo, NE 68824 <br />AFFIDAVIT OF MARITAL STATUS <br />: • � : :_:T.�� <br />COUNTY OF HALL <br />) <br />) ss: <br />) <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the <br />following information is true and correct: -� <br />1. <br />Name of Decedent: Florence M. Hadenfeldt <br />Date of Death: March 14, 2012 <br />Domicile at Date of Death: 206 West Syria, Cairo, NE 68824 <br />Name of Surviving Spouse: Donald L. Hadenfeldt <br />Date of Marriage: December 29, 1960 <br />A copy of the Certificate of Death for Florence M. Hadenfeldt is attached to this Affidavit of <br />Marital Status as E�ibit "A." <br />2. <br />3. <br />� <br />The Affiant is related to the Decedent as follows: Husband <br />There is no Federal Estate Tax, Nebraska Inheritance T� or Nebraska Estate Tax. <br />Title to the following described real estate is held by the Decedent and the surviving <br />spouse of the Decedent in joint tenancy, to wit: <br />i� <br />Page 1 of 3 <br />