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1 L <br /> 15, ITt <br /> O! a0 es a _� w Ni o t '—� <br /> rn <br /> C D <br /> 0 ` `" -` -_, 0 <br /> co <br /> C c_., rU "I4 c� 3 <br /> 0 <br /> AFFIDAVIT OF MARITAL STATUS n <br /> STATE OF NEBRASKA ) 01 <br /> )ss. <br /> COUNTY OF HALL ) <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: Thomas M.Conlon <br /> Date of Death: August 28,2013 <br /> Domicile at Date of Death: Hall County,Nebraska <br /> Name of Surviving Spouse: Faye L. Conlon <br /> Date of Marriage: February 21, 1984 <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 /> See Attached <br /> (Known as 819 S. Stuhr Rd., Grand Island,Hall County,Nebraska) <br /> 5. As of the date of death,the real estate has a fair market value of$161,289.25 <br /> 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br /> Iien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason <br /> 1 of Nebraska Revised Statutes Section 77-2102. <br /> FURTHER AFFIANT SAITH NOT. <br /> Faye L.Conlon <br /> SUBSCRIBED and SWORN to before me this 28 day of October,2013. <br /> Al X---"s, _AN, . ....- l t (,l <br /> Public <br /> I <br /> GENERAL NOTARY-State of Nebraska <br /> : BONNIE L.WILL <br /> IR. . pily Comm.Exp June 28,2015 <br /> I <br />