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co <br />CD <br />01 Crl 5 � _ <br />I A VC <br />Q <br />AFFIDAVIT OF MARITAL STATUS <br />,j <br />czn <br />r <br />co <br />MD <br />:3 <br />1—• <br />STATE OF NEBRASKA ) <br />ss: <br />COUNTY OF HALL <br />COMES NOW the undersigned, being duly sworn, deposes and <br />says that the undersigned is the surviving spouse of the Decedent <br />and that the following information is true and correct: <br />1. Name of Decedent: Ronald B. Bailey <br />Date of Death: December 6, 2014 <br />Domicile at Date of Death: Grand Island, Nebraska <br />Name of Surviving Spouse: Willa J. Bailey <br />Date of Marriage: August 13, 1956 <br />2. The Affiant is related to the Decedent as follows: <br />Surviving Spouse <br />3. There is no federal estate tax, Nebraska inheritance tax <br />or Nebraska estate tax due. <br />4. Title to the real estate, as set forth below, is held by <br />the Decedent and the surviving spouse of the Decedent in joint <br />tenancy: <br />Lot Thirty -One (31), Jeffrey Oaks Subdivision in the City of <br />Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair <br />market value of: <br />$163,697.00 <br />