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065001.Z0Z <br />rn <br />N t% <br />Cl) <br />Return to: <br />Denise D. Myers <br />P.O. Box 505 <br />Cairo, NE 68824 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA <br />) ss. <br />COUNTY OF HALL <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states <br />that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the <br />following information is true and correct. <br />1. Name of Decedent: Larry L. Stutzman <br />Date of Death: December 14, 2020 <br />Domicile at Death: Cairo, Hall County, Nebraska <br />Name of Surviving Spouse: Shirley Ann Stutzman <br />Date of Marriage: September 25, 1959 <br />2. The Affiant is the attorney for the Decedent's spouse and, in that capacity, is familiar <br />with the 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 Twelve (12), Block Three (3), in Ingalls -Turner Subdivision to the Town of <br />Cairo, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $151,925. <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 />FURTHER Affiant sayeth not. <br />Denise D. Myers <br />Subscribed and sworn to before me this `9 - day of , 2021. <br />Notary Public <br />GENERAL NOTARY- State of Nebraska <br />SUSAN R. MRKVICKA <br />My Comm. Exp. June 8, 2021 <br />IUB <br />C TERED AS INSTRUMENT NC <br />