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Return to: <br />Kevin A. Brostrom <br />1811 W. 2nd St., Ste 360 <br />Grand Island, NE 68803 <br />(In <br />rn N <br />n= <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />COUNTY OF HALL ) <br />ss: <br />COMES NOW, the undersigned, being duly sworn, deposes and states that the undersigned <br />is the surviving spouse of the Decedent, and that the following information is true and correct: <br />1. Name of Decedent: Allen Dale Rein <br />Date of Death: April 26, 2019 <br />Domicile at Date of Death: Grand Island, Nebraska <br />Date of Marriage: December 30, 1961 <br />2. The Affiant is the surviving spouse of the decedent. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax <br />that arose, or can arise, that is due because of decedent's death. <br />4. Title to the following described real estate was held by the Decedent and Mary Jane <br />Rein, on the date of the Decedent's death, to -wit: <br />Lot Four (4), Block Eight (8) in Schimmer's Addition to the City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair market value of $94,160.00. <br />6. The Decedent and Affiant were married as of the date of death. There is no <br />Nebraska Inheritance Tax lien, by reason of Nebraska Revised Statute § 77-2003. <br />There is no Nebraska Estate Tax lien by reason of Nebraska Revised Statute § 77- <br />2102. <br />AND FURTHER AFFIANT SAITH NOT. <br />Subscribed and sworn to before me this <br />--day of <br />Notary P blic <br />2019. <br />GENERAL NOTARY - State of Nebraska <br />KEVIN A. BROSTROM <br />J ` My Comm. Exp. September 25, 2022 <br />ON 1N3Wf1}J1SNI SV a3I31N3 <br />