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STATE OF NEBRASKA ) <br />ss: <br />COUNTY OF HALL <br />77 -2102. <br />PREPARED BY: <br />Mary J. Livingston #16122 <br />Attorney for Affiant <br />P. 0. Box 1563 <br />Grand Island, NE 68802 <br />(308) 381 -7301 <br />m <br />-n <br />r <br />^ ° <br />rt min <br />Z <br />AFFIDAVIT OF MARITAL STATUS <br />The undersigned, being duly sworn, deposes and says that the <br />following information is true and correct: <br />1. Name of Decedent: James Edward Urban <br />Date of Death: November 8, 2015 <br />Domicile at Date of Death: Grand Island, Nebraska <br />Name of Surviving Spouse: Celia R. Urban <br />Date of Marriage: September 2, 1995 <br />2. The Affiant is related to the Decedent as 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: Lot Thirteen (13), Coach Place Subdivision in the City <br />of Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair <br />market value of $117,709.00. <br />6. The Decedent and Affiant were married as of the date of <br />death. There is no Nebraska inheritance tax lien by reason of <br />Nebraska Revised Statutes Section 77 -2003. There is no Nebraska <br />estate tax lien by reason of Nebraska Revised Statutes Section <br />'-/ <br />is R. (Urban, A fiant <br />SUBSCRIBED AND SWORN to before me this day of <br />December, 2015. <br />