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s <br />p <br />Return to: <br />Galen E. Stehlik <br />P O Box 400 <br />Grand Island NE 68802 <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />144_ E <br />I <br />AFFIDAVIT OF MARITAL STATUS <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Lee A. Mills <br />Date of Death: June 29, 2013 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Carolyn K. Mills <br />Date of Marriage: September 8, 1974 <br />2. The Affiant is related to the Decedent as follows: Surviving Spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because <br />of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to -wit: <br />Lot Eight (8) Jack Voss Horse Country Club Second Subdivision in the <br />City of Grand Island, Hall County, Nebraska; and <br />Lot Seven (7), Capital Heights Eighth Subdivision, in the City of <br />Grand Island, Hall County, Nebraska. <br />jzs GENERAL NOTARY - State of Nebraska <br />BONNIE WILL <br />My Comm. l Exp lone 28, 2015 <br />&id K <br />Carolyn K. Mills <br />SUBSCRIBED and SWORN to before me thisJJday of <br />otary Public <br />5. As of the date of death, the real estate has a fair market value of $297,006.46. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77 -2102. <br />FURTHER AFFIANT SAITH NOT. <br />, 2013. <br />rn <br />0 73 <br />t � <br />c : <br />Ul <br />N . <br />J6.06 <br />