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-1 'Z_ fi j2 9) Return to: Gayle M Hinrichs P.O. Box 74 Cairo, NE 68824 STATE OF NEBRASKA COUNTY OF HALL ) ss. AFFIDAVIT OF MARITAL STATUS Belinda R. Hinrichs Notary ° • is UneUr to U Eft I Q . 5M ITfl, Th.ra- lt)c„1 Subscribed and sworn to before me this day of June, 2013. w CO —{ C c- -r m ry C CO cr) COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Phillip R. Hinrichs Date of Death: August 16, 2012 Domicile at Death: Cairo, Hall, Nebraska Name of Surviving Spouse: Gayle M. Hinrichs Date of Marriage: August 12, 1975 2. The Affiant is the daughter of the Decedent and, in that capacity, is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to -wit: Commencing at a point Three Hundred feet (300 ft) south of the intersection of the south line of Syria Street with the East line of High Street of the First Addition to the town of Cairo (according to the recorded plat thereof), said point of intersection being 60 feet South of the Southwest corner of Lot seven (7), in Block three (3), of the said First Addition; thence South in continuation of the East line of the said High Street 138.4 feet to intersect the South line of the Southwest Quarter of the Northwest Quarter (SW1 /4NW1/4) of Section 19, in Township 12 North, Range 11, West of the 6 P.M.; thence East along said South line 140 feet to intersect the West line of the alley of Block 1, of the Fifth Addition to the said Town of Cairo, (according to the recorded plat thereof), extended South; thence North in said last mentioned line 138.4 feet; thence West in a line parallel to the South line of Syria Street 350 feet South thereof 140 feet to the place of beginning, in Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $74,642.00. 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77 -2003. FURTHER Affiant saith not. N OICOALFWIR • ; °FAtNOR/8 5 _ CONSULAND A NOTARY PUBUG • m S � lJ�ui 1 • 1.0(1.-1E---.10443/,%.4/ • GP \-;