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Return to: <br />Galen E. Stehlik <br />P.O. Box 400 <br />Grand Island, NE 68802 -0400 <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />X = <br />AFFIDAVIT OF MARITAL STATUS <br />) ss. <br />Fri <br />C) <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is <br />the surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Faye Lorraine Wagner, <br />formerly known as Faye Lorraine Conlon <br />Date of Death: November 17, 2017 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Mikel D. Wagner <br />Date of Marriage: February 25, 2017 <br />2. The Affiant is related to the Decedent as follows: Surviving Spouse. <br />3. The Decedent and Affiant were married as of date of death. There is no Nebraska <br />Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no <br />Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77 -2102. <br />4. Pursuant to the decedent's Will admitted to probate in Hall County Probate case <br />PR17 -285, the real estate shown on attached Exhibit "A" passed to your affiant herein. <br />FURTHER AFFIANT SAITH NOT. <br />Mikel D. agner <br />SUBSCRIBED and SWORN to before me this `ay of August, 2018. <br />( kL o <br />Notary Public <br />dee GENERAL NOTARY - Stale of Nebraska <br />MELISSA SUTTON <br />My Comm. Exp. October 20, 2021 <br />Fr <br />rn <br />d <br />cm A <br />co <br />Leer <br />CD —I; <br />CO <br />C7) <br />CO <br />a <br />