Laserfiche WebLink
Return to: <br />Galen E. Stehlik <br />V P.O. Box 400 <br />Grand Island, NE 68802-0400 <br />rn <br />c <br />a <br />z <br />(W <br />nn <br />r <br />m <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />0) <br />77-7 <br />r1 <br />rn <br />--+ ry b <br />c __+ r' <br />(:-:— z <br />WeaT.,.„,,-3,Q7l <br />CD <br />r r- > C.) �'l <br />C <br />co - A <br />rV► <br />ry co 6 1 <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Keith A. Fischer <br />Date of Death: April 15, 2019 <br />Domicile at Date of Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Jane A. Fischer <br />Date of Marriage: <br />2. The Affiant is related to the Decedent as follows: Surviving Spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due <br />because of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of <br />the Decedent in joint tenancy, to -wit: <br />Lot Eleven (11), in Westwood Park Seventh Subdivision in the City of <br />Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair market value of $283,035.86. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance <br />Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by <br />reason of Nebraska Revised Statutes Section 77-2102. <br />FURTHER AFFIANT SAITH NOT. <br />SUBSCRIBED and SWORN to before me this day of June, 2019. <br />GENERAL. NOTARY - State of Nebraska <br />en_L11 PAMELA S. TAYLOR <br />• My Comm. Exp. April 21, 2021 <br />_2 2”am1 cKJ <br />Notary Public <br />