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- <br />- <br />�� <br />N � <br />A �� <br />�� <br />� �� <br />N �� <br />� �� <br />W <br />� �� <br />� <br />-p �� <br />- <br />- <br />�� <br />�� <br />- <br />� <br />� <br />� � <br />�Y�� <br />�� <br />� �. <br />� � <br />_� D <br />r � <br />� `� <br />n ,,• <br />f*1 ��' Y . <br />�� �.-: <br />--� <br />� <br />0 <br />� r''�, <br />� �4. <br />;.J �a , <br />�� <br />fTl � <br />� �� <br />AFFIDAVIT OF MARITAL STATUS <br />f y <br />G� <br />�--� <br />� <br />� <br />--c <br />� <br />� <br />�� <br />� <br />!-� <br />�.l <br />i _' <br />�0 <br />n � <br />o -1 <br />C � <br />z rn <br />� <br />� o <br />o � <br />TI Z <br />� rn <br />A � <br />� � <br />r n <br />U� <br />� <br />y <br />�... � <br />� <br />� <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that <br />the undersigned knows the Decedent and is the surviving spouse of the Decedent and that the <br />following information is true and correct. <br />1. Name of Decedent: June M. Griebel <br />Date of Death: March 12, 2012 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Allan L. Griebel <br />Date of Marriage: August 17, 1979 <br />2. The Affiant is the surviving spouse of the Decedent and in that capacity is familiar <br />with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance t� or Nebraska estate tax <br />due. <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />Lot Eleven (11), in Ross-Theasmeyer Subdivision, City of <br />Grand Island, Hall County, Nebraska <br />5. As of the date of death, the real estate had a fair market value of $176,621.51. <br />6. The Decedent and the surviving spouse were married as of the date of death. There <br />N <br />O <br />t—� <br />r� <br />CJ <br />W <br />� <br />� <br />rrir <br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There is no <br />Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />. <br />Allan L. Griebel, Affiant <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />ss: <br />SUBSCRIBED and sworn to before me on this ��day of e� , 2012 <br />by Allan L. Griebel, Affiant. <br />u <br />� <br />R <br />� <br />� <br />afij <br />�'. <br />: <br />A1 <br />:� <br />'� � <br />� <br />GENERAI. NOTARY - State ot Nebraska <br />JAMIE PI{UES JANKOVITZ � � �, <br />My Ccmm. Exp. May 25, 2014 � <br />t Pub ic <br />PREPARED BY: <br />� _ 1 Jamie Mues Jankovitz, #20754 <br />`J� BRADLEY, ELSBERND, ANDERSEN, <br />KNEALE & MUES JANKOVITZ, P.C. <br />202 West Third Street <br />P.O. Box 639 <br />Grand Island, NE 68802 • <br />Telephone: (308) 382-2128 <br />