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FURTHER THIS AFFIANT SAYETH NOT. STATE OF NEBRASKA COUNTY OF HALL by Kaye M. Ernstmeyer, Affiant. ) s 6 NERN. NOTARY - State of Nebraska JAMIE MUSS JANKOVITZ My Comm. Exp. May 25, 2018 PREPARED BY: Jamie Mues Jankovitz, #20754 BRADLEY, ELSBERND, ANDERSEN, MUES JANKOVITZ & KEARNEY, P.C. 202 West Third Street P.O. Box 639 Grand Island, NE 68802 Telephone: (308) 382 -2128 m c n z n� �c= = nI AFFIDAVIT OF MARITAL STATUS ary Public i Ka j M. Ernstmeyer, Affiant SUBSCRIBED and sworn to before me on this /9? day of �Zt r., s C.) .7:17) Z N 0 0 - v, F--1 rn co cp c r D. c i ►—+ CJ) t- a A C4 CPI Cr) w C Comes Now, the undersigned, being first duly sworn upon oath, 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 W. Ernstmeyer Date of Death: August 5, 2014 Domicile at Death: Hall County, Nebraska Name of Surviving Spouse: Kaye M. Ernstmeyer Date of Marriage: June 2, 1973 2. The Affiant is the wife 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: Lot Six (6), Block Fourteen (14), In Charles Wasmer's Addition to the City of Grand Island, Hall County, Nebraska And 4 ;iv P /y of 41tn) 1su3ND, Lot Seven (7), Block four (4), H.G. Clarks Addition, Hall County, Nebraska 5. As of the date of death, the real estate had a fair market value of $178,042.00 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason ofNebraska Revised Statute § 77 -2003. There is no Nebraska estate tax lien by reason ofNebraska Revised Statute §77 -2102. A Aic 4 11111111 _ , 2014 m --1 t 1;()