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Return to: Denise Myers <br />611 N. Diers Ave., Ste. 1 <br />Grand Island, NE 68803 <br />FURTHER Affiant saith not. <br />GENERAL. NOTARY - State of Nebraska <br />II KELUE G. HOFFART <br />My Comm. Exp. July 17, 2018 <br />m <br />m <br />Z <br />ri <br />z <br />n r <br />r <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />enise D. Myers <br />Subscribed and sworn to before me this c?4.L day of April, 2016. <br />—c <br />r "J <br />co <br />m <br />'f) <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: Dixie D. Fringer, also known as Dixie D. Scott <br />Date of Death: March 8, 2016 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Ronald E. Fringer <br />Date of Marriage: April 15, 2011 <br />2. The Affiant is the attorney for the Decedent's spouse and, in that capacity, is <br />familiar with 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 />Lot Fifteen (15) and the Southerly One -half (S1/2) of Lot Thirteen (13), in <br />Block Six (6), in University Place, an Addition to the City of Grand Island, Hall <br />County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $104,160.00. <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 />CD <br />co <br />(J <br />1 <br />) <br />