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2u�2u�5�� AF�IDAVIT OF MARITAL STATUS Comes Now, the undersigned, being first duly swom upon oath, deposes and states that the undersigned lmows tha Decedent and the surviving spouse of the Decedent and that the following information is true and conect. 1. Name of Decedent: Victor G. Jensen Date of Death: March 7, 2008 Domicile at Death: Hall County, Nebraska Name of Surviving Spouse: Marian I. Jensen Date of Marriage: ��U S�' �v i �� y Cc 2. The Affiant is the son of the De�edent and in that capacity is familiar with the marital status aad the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to tha following described real �tate is held by the De�edent and We surviving spouse in joint tenancy, to w+it: Lot Ten (10), Fonner View Subdivision in the City of Grand Island, Hall County, Nebtaska. 5. As of the date of death, the real estate had a Hall County assessed fair market value of $88,600.00. 6. The Decedent and the surviving spouse were matried as of tl�e date of death. Ther� is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. FURTHER TffiS AF'FIANT SAYETH NOT. A .._.-.�i:.�'� �? ��; � -� -i `� STATE OF NORTH CAROLINA ) COUNTY OF h(p�Y� _ � ss: SUBSCRIBED and sworn to before me on t�is � day o��,�ll� , 2012 by Donald I. Jensen, Ai�iant. �� ANY N. NARRIS �l�T,4RY PUBLIC �s��ouv cOUnin� @U�FiI'H CAROUNA MY C�lu9�l,�IDN EXPI6iES NOVEM96� �, �16 �.I�.�...e ' I/ . , '�!� , , PREPARED BY: Jemie Mees dankovitz, #20754 BRADLEY,ELSBERND,ANDERSEN, K�'Ai.� & MUES,�ANKOVITZ,1'.C. 202 West Third Street P.O. Box 639 Grand Island, ATE 68802 Telephone: (308) 382-2128