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,-(.) p 6 q m n n cc) rn = > c, "1 c rn N z I `r r w • cri co STATE OF NEBRASKA COUNTY OF HALL ss. AFFIDAVIT OF MARITAL STATUS Notary Public SUBSCRIBED and SWORN to before me this gay of March, 2018. KT, rT Cr) -H rr COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Rodney James Clark Date of Death: February 3, 2018 Domicile at Date of Death: Grand Island, Hall County, Nebraska Name of Surviving Spouse: Linda May Clark Date of Marriage: June 29, 1975 2. The Affiant is related to the Decedent as follows: Surviving Spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to -wit: A tract of land comprising a part of the Northwest Quarter (NW 1 /4)'of Section Twenty -Six (26), Township Eleven (11) North, Range Ten (10) West of the 6t P.M. in Hall County, Nebraska, more particularly described as follows: beginning at a point on the northerly right - of -way line of the Union Pacific Railroad Company, said point being Two Hundred Twenty - Five (225.0) feet Southwesterly from the intersection of said right -of -way line with the east line of said Northwest Quarter (NW1 /4); thence northerly parallel to said east line of the Northwest Quarter (NW 1/4), a distance of Two Hundred Twenty -Five (225.0) feet; thence southwesterly parallel to said right -of -way line, distance of One Hundred Twelve and Five Tenths (112.5) feet; thence southerly parallel to said east line of the Northwest Quarter (NW1 /4), a distance pf Two Hundred Twenty -five (225.0) feet, to said right -of -way line; thence northeasterly a long said right -of -way line, a distance of One Hundred Twelve and Five Tenths (112.5) feet to the place of beginning. Also known as: Lots One (1) and Two (2), C & E Subdivision, in the City of Grand Island, Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $182,183.92. 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77 -2102. FURTHER AFFIANT SAITH NOT. Linda May Clark