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Return to: <br />Galen Stehlik <br />PO Box '400 <br />Grand Island NE 68802 <br />AND <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />X V/. t AW4 u Netasta ` <br />GALEN E. STEHLNC <br />My Conan. Exp. May 1,201$ <br />AFFIDAVIT OF MARITAL STATUS <br />r '' <br />reg <br />:3 <br />CD <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: Shelly Ann Heusel <br />Date of Death: October 3, 2014 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Steven L. Heusel a/ka Steve Heusel <br />Date of Marriage: March 23, 1974 <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 One (1) Block (2) Colonial Estates 10 Subdivision to the City of Grand Island, <br />Hall County, Nebraska; (fair market value $292,385.00) <br />Lot Four (4) and the West One -Half (W112) of Lot Three (3), Block Thirty -Seven (37), <br />Original Town of Grand Island, Hall County, Nebraska. (fair market value $127,927.00) <br />5. As of the date of death, the real estate above described have a fair market value of $420,312.00. <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 />Steven L.Heusel a/k/a Steve Heuse <br />SUBSCRIBED and SWORN to before me this 15th day of October, 2014. <br />Public <br />