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(.n <br />MOMMUMmOmM <br />N <br />C31 <br />m <br />co <br />o, <br />Return to: <br />Galen Stehlik <br />PO Box 400 <br />Grand Island NE <br />68802 <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />See attached. <br />)s <br />otary Public <br />AFFIDAVIT OF MARITAL STATUS <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: Thomas C. Hulme, Sr. <br />Date of Death: July 24, 2014 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Gala R. Hulme <br />Date of Marriage: April 7, 1960 <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 />ete.a.44-)P,M, <br />Gala R. Hulme J <br />SUBSCRIBED and SWORN to before me this �3 day of (NI/AA , 2015. <br />5. As of the date of death, the real estate has a fair market value of $847,845.27. <br />(value provided by the Hall County Assessor, adjusted for fair market value). <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 />