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1Return to: Jamie Mues Jankovitz 202 W. 3rd St. OL) Grand Island, NE 68801 ��j/'' AFFIDAVIT OF MARITAL STATUS n- _> CP '. c:7. .: - O ="i --a • rnn :x]2' --c —< a;' 7 0 N CD -,i A) &) m r- r- > v--- Yr N Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Roger A. Cline Date of Death: April 19, 2019 Domicile at Death: Hall County, Nebraska Name of Surviving Spouse: Elizabeth E. Cline Date of Marriage: June 8, 1969 2. The Affiant is the wife of the Decedent and in that capacity is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to wit: Lot Eleven (11), Block Two (2), Woodland Park Fourth Subdivision, In the City of Grand Island, Hall, County. Nebraska. (Physical Address: 41-18 Iowa Ave., Grand Island' NE) 5. As of the date of death, the real estate had a fair market value of $259,925.00. 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. FURTHER THIS AFFIANT SAYETH NOT. STATE OF NEBRASKA ss: COUNTY OF HALL Elizal eth E. Cline, Affiant SUBSCRIBED and sworn to before me on this Elizabeth E. Cline, Affiant. GENERAL NOTARY - State of Nebraska JAMIE MUES JANKOVITZ ilj .. My Comm. Exp. May 25, 2022 PREPARED BY: Jamie Mues Jankovitz, #20754 BRADLEY LAW OFFICE, PC 202 West Third Street Grand Island, NE 68801 Telephone: (308) 382-2128 day of'11( ,2019 by ryuL) �'�u �--)&ft—lc Notary Public Page I of I