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Return to: Denise 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 />FURTHER Affiant saith not. <br />GENERAL NOTARY - state of Nebraska <br />DENISE D. MYERS <br />My Can►, Exp. Nov. 20, 2014 <br />Lisa Ann Pattison <br />Notary Public <br />a C7 Cf> <br />C D (V <br />_4 4 rr4 <br />F...J T -M <br />_ m <br />rr- o <br />CO <br />CD v O <br />tro <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: Daniel James Sullivan, V <br />Date of Death: December 24, 2012 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Gloria H. Sullivan <br />Date of Marriage: August 28, 1949 <br />2. The Affiant is the daughter of the Decedent and, in that capacity, is familiar with <br />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 Three (3), Country Meadows Second Subdivision, in the City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $151,503.00. <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. <br />7441,,,d„ / 42x re-a- <br />Subscribed and sworn to before me this q day of January, 2013. <br />I to <br />0° <br />