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Retum to: Denise Myers <br />611 N. Diers Ave., Ste. 1 <br />Grand Island, NE 68803 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Harold H. Kuck <br />Date of Death: July 26, 2013 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Rose A. Kuck <br />Date of Marriage: June 12, 1949 <br />2. The Affiant is the daughter the Decedent and, in that capacity, is familiar with the <br />marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />The Westerly Sixty Five Feet (W65') and the Easterly Twenty -one Feet <br />(E21') of Lot Five (5), Pleasant View 5 Subdivision to the City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $103,710.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. <br />FURTHER Affiant saith not. <br />Subscribed and sworn to before me this 2eo day of August, 2013. <br />�j' <br />b . -� :- <br />? ni X .71) <br />ft Z: <br />tit <br />Debra K. Lemburg <br />otary Public <br />C7 Co <br />rri <br />(D <br />(. <br />