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01� <br />cn <br />313 <br />W <br />r"1 _i� <br />c7 3 <br />r <br />v F—+ <br />CD <br />r� CD <br />h <br />(I) <br />DEATH CERTIFICATE AND AFFIDAVIT OF MARITAL STATUS <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />information is true and correct. <br />1. Name of Decedent: James William Wiegert, (aka James W. Wiegert) <br />Date of Death: February 24, 2019 (Death certificate attached) <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Linda Gail Wiegert <br />Date of Marriage: August 19, 1967 <br />2. The Affiant is the wife of the Decedent and in that capacity is familiar with the <br />marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax <br />due. <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />Lot Eleven (11), Block Eleven (11), Ashton Place Addition, to the City of <br />Grand Island, Hall County, Nebraska. <br />(Physical Address: 2519 W. Division St., Grand Island, Nebraska) <br />And <br />Lot Eleven (11), Block Five (5), Ashton Place Addition, to the City of <br />Grand Island, Hall County, Nebraska. (Physical Address: 2319 W. <br />Charles St., Grand Island, Nebraska) <br />5. As of the date of death, the real estate had a fair market value of $121,307.00 and <br />$117,884.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. There <br />is no 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 §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />Linda Gail Wiegert (aka Linda G.'Wiegert), <br />Affiant <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />SUBSCRIBED and sworn to before me on this day of /°r/t I (x,� , 2019 <br />by Linda Gail Wiegert (aka Linda G. Wiegert), Affiant. <br />GENERAL NOTARY- State of Nebraska <br />JAMIE MUES JANKOVITZ <br />My Comm. Exp. May 25, 2022 <br />PREPARED BY: <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY LAW OFFICE, PC <br />202 West Third Street <br />Grand Island, NE 68801 <br />Telephone: (308) 382-2128 <br />jamie(a,bradleylawo(flee. corn <br />�� IYti�i ) C,,- A.JJ-e;'-eiP <br />Notary Public <br />