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:G A f1 <br />tin <br />A z 9 <br />A0 <br />e 2:041 <br />a <br />Return to: Denise Myers <br />611 N. Diers Ave., Ste. 1 <br />Grand Island, NE 68803 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />Ti <br />Cr) <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Wayne Victor Pennell <br />Date of Death: October 21, 2015 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Lois R. Pennell <br />Date of Marriage: October 14, 1962 <br />2. The Affiant is the attorney for the Decedent and, in that capacity, is familiar with <br />the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />All of Lots Five (5) and Seven (7), and the North Forty One (41) Feet of Lot <br />Nine (9), in Block Twenty Nine (29) in Highland Park, in the City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $123,579. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. <br />FURTHER Affiant saith not. <br />Denise D. Myers <br />Subscribed and sworn to before me this `r day of January, 2016. <br />GENERAL NOTARY -State of Nebraska <br />KELUE G. HOFFART <br />My Comm. Exp. July 17, 2018 <br />Altti <br />v <br />N <br />CD <br />CD <br />CD <br />CO <br />