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Return To: Denise D. Myers <br />611 N. Diers Ave., Ste 1 <br />Grand Island, NE 68803 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Donald H. Gloe <br />Date of Death: November 9, 2012 <br />Domicile at Death: Wood River, Hall County, Nebraska <br />Name of Surviving Spouse: Renee M. Gloe <br />Date of Marriage: February 19, 1966 <br />2. The Affiant is the daughter of the Decedent and his surviving spouse and, in that <br />capacity, is familiar with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lot One (1), in Gloe Subdivision, in Section Ten (10), Township Ten (10) <br />North, Range Eleven (11), West of the 6 P.M., Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $122,650.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance, tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. <br />GENERA. NOTON • state of Newaskt <br />UNDA L DUESTER <br />My Comm. Exp. March 4204 <br />Subscribed and sworn to before me this <br />Notary Public <br />day of <br />C :r <br />( <br />CD <br />N) <br />CD <br />c.n <br />coo <br />2012. <br />