Laserfiche WebLink
1 � <br />CSINUNIMrOMININIMEMINN <br />2, <br />rn <br />n <br />z <br />=no <br />n = <br />Return to: Denise D. Myers <br />VP.O. Box 505 <br />Cairo, NE 68824 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />rn <br />rn <br />Lest!s <br />--1 <br />443 <br />C <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: <br />Date of Death: September 26, 2021 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Billie G. Klimek <br />Date of Marriage: July 19, 1967 <br />2. The Affiant is the Decedent's attorney and, in that capacity, is familiar with the marital <br />status and the death of the Decedent. <br />3. That there is no federal estate tax or Nebraska inheritance tax 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 />See attached Exhibit "A". <br />5. As of the date of death, the real estate had a fair market value of $486,860. <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 a s - day of (e.uur\bir, 2021. <br />jimmeGENERAL NOTARY -Mate of Nebraslce <br />SUSAN R. MRKVICKA <br />My Connt. E Itne 8, 2025 <br />Notary Public <br />