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Retum to: Kevin A. Brostrom Lauritsen, Brownell & Brostrom, PC, LLO 1811 W. 2nd St., Ste 360 Grand Island, NE 68803 AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ss. COUNTY OF HALL r\) CD CO cJl rn ---1 rn N rl Q Q r\) t—+ (0 C CO rn cn Ara) COMES NOW, the undersigned, being duly sworn, deposes and states that the undersigned is the surviving spouse of the Decedent, and that the following information is true and correct: 1. Name of Decedent: Donald P. Whelan Date of Death: July 5, 2021 Domicile at Date of Death: Hall County, Nebraska Date of Marriage: September 24, 1979 2. The Affiant is the surviving spouse of the decedent. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that arose, or can arise, by virtue of the Decedent's death. 4. Title to the following described real estate was held by the Decedent and Patricia D. Whelan as joint tenants, the Decedent's spouse, on the date of the Decedent's death, to -wit: Lot Twenty-seven (27), Block "C" in Parkview Subdivision, located in the Northeast Quarter (NE1/4) of Section Twenty-nine (29) and the Northwest Quarter (NW 1/4) of Section Twenty-eight (28), both in Township Eleven (11) North, Range Nine (9) West of the 6th P.M.., in Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $199,439.00. 6. The Decedent and Affiant 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 AFFIANT SAITH NOT. afit;t4; uA\QQ/ Patricia D. Whelan Subscribed and sworn to before me this I day of September 2021. GENERAL NOTARY- State of Nebraska KEVIN A. BROSTROM My Comm. Exp. September 25, 2022 Not blic