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CO <br />MEINIIMMIO <br />Return t Denise Myers <br />,� P.O. Box 505 <br />Cairo, NE 68824 <br />FURTHER Affiant saith not. <br />GENERAL NOTARY - State of Nebraska <br />SUSAN R. MRKVICKA <br />My Comm. Exp. June 8, 2021 <br />Denise D. Myers <br />!V <br />CD <br />Co <br />_r: <br />C) <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br /><1) <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 ofthe Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Roger E. Jensen <br />Date of Death: January 31, 2018 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Connie J. Jensen <br />Date of Marriage: July 19, 1959 <br />2. The Affiant is the attorney for the Decedent and Decedent's spouse, and in that <br />capacity, is 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 />Lots Three (3) and Four (4), Block Two (2), Harrison's Subdivision, an <br />Addition to the City of Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $164,179. <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 />rc <br />Subscribed and sworn to before me this ?3 day of May, 2018. <br />l _:: <br />Notary Public <br />