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STATE OF NEBRASKA COUNTY OF HALL ) ss: 1� Affi ant. GENERA. NOTAflY- State oR Nebraska JAMIE MUES JANKOVITZ My Comm. Eap. 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 -n c z n X_ AFFIDAVIT OF MARITAL STATUS FURTHER THIS AFFIANT SAYETH NOT. SUBSCRIBED and sworn to before me on this 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: • Carol Ann Smith Date of Death: August 13, 2014 Domicile at Death: Hall County, Nebraska Name of Surviving Spouse: Gary L. Smith Date of Marriage: July 16, 1982 2. The Affiant is the husband 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 Seven (7), Block Twenty -One (21), Packer and Barr's Second Addition to the City of Grand Island, Hall County, Nebraska 5. As of the date of death, the real estate had a fair market value of $55,315.00 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77 -2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. -4-frotejt Gary L. Smith, Affiant -4 -i m 0 ( Le. 'day of ('i' -krYl eA , 2014