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0 - 11 <br />C <br />� - <br />- A1)p.t <br />Return to: <br />Galen Stehlik <br />P 0 Box 400 <br />Grand Island, NE 68802 <br />STATE OF NEBRASKA ) <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: Kenneth Lee Hoffman <br />Date of Death: November 15, 2013 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Joyce M. Hoffman <br />Date of Marriage: May 5, 1962 <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), Morningside Acres Third Subdivision, in the City of Grand <br />Island, Hall County, Nebraska; <br />And <br />1 <br />AFFIDAVIT OF MARITAL STATUS <br />01 <br />N <br />ca <br />Lot Two (2) Stearn's Subdivision to the City of Grand Island. Hall County, Nebraska. <br />ad o <br />U <br />5. As of the date of death, the real estate has a fair market value of $480,668.82. <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 />SUBSCRIBED and SWORN to before me this 3 r L day of December, 2013. <br />Notary Public <br />GENERAL NOTARY -State of Nebraska . SKEEN <br />MY Comm. Exp. July 19, 2015 <br />