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due. <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />GENERAL NOTARY • State of Nebraska <br />JAMIE MUES JANKOVITZ <br />My Comm. Exp. May 25, 2014 <br />PREPARED BY: <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY, ELSBERND, ANDERSEN, <br />KNEALE & MUES JANKOVITZ, P.C. <br />202 West Third Street <br />P.O. Box 639 <br />Grand Island, NE 68802 <br />Telephone: (308) 382 -2128 <br />AFFIDAVIT OF MARITAL STATUS <br />r ^.3 m <br />D w C To- r i <br />o . a 0 d r, <br />n S r ri CJ Z_ <br />r r- xo D <br />tJ f ' H (0 <br />o F-+ kn V) <br />T1 CD x Cr) a <br />rn <br />o O co Iti C a <br />cn cn <br />-4 <br />0 0 <br />Comes now, the undersigned, being first duly sworn upon oath, deposes and states that the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />information is true and correct. <br />1. Name of Decedent: Gonzalo Luevano -Salas <br />Date of Death: August 23, 2013 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Rosa Luevano <br />Date of Marriage: March 2, 1972 <br />2. The Affiant is the surviving spouse of the Decedent and in that capacity is familiar <br />with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />The Southerly Eighty Two (82) Feet of Lot Eight (8), in Fractional Block Nineteen <br />(19), in Rollins' Addition to the City of Grand Island, Hall County, Nebraska, being <br />a rectangular tract of ground having a Southerly Frontage of Sixty -Six (66) Feet on <br />Front Street in said City, and a depth of Eighty Two (82) Feet <br />5. As of the date of death, the real estate had a fair market value of $42,753.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. There <br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77 -2003. There is no <br />Nebraska estate tax lien by reason of Nebraska Revised Statute §77 -2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />po- <br />Rosa Luevano, Affiant <br />SUBSCRIBED and sworn to before me on this 4'7 day of {)6-et ens , 2013 <br />by Rosa Luevano, Affiant. <br />0 <br />