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4 <br />GALEN E. STEHLIK <br />Lauritsen Brownell Brostrom & <br />Stehlik, PC, LLO <br />PO Box 400 <br />Grand Island, NE 68802 -0400 <br />ofti <br />c <br />VI <br />wkA i <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <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: Barry D. Schultz <br />Date of Death: December 25, 2014 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Debra L. Schultz <br />Date of Marriage: March 22, 1975 <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 Three (3), Block Two (2), Capital Heights Third Subdivision <br />to the City of Grand Island, Hall County, Nebraska. <br />(Known as 4252 Vermont Ave., Grand Island, Nebraska) <br />5. As of the date of death, the real estate has a fair market value of $117,632.00 <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 />Debra L. Schultz <br />4252 Vermont Ave. <br />Grand Island, NE 68803 <br />SUBSCRIBED and SWORN to before me this day of August, 2015. <br />WNW -Slate of Nebraska <br />GALEN E. STEHUK <br />My Comm. E. May 1, 2018 <br />CG' <br />tJ <br />U1 cry <br />I h am <br />c) V <br />cD <br />