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N� <br />Nimuummorma <br />m <br />01minwairmin <br />isOsionsmei <br />r.� <br />CD <br />Return to: Denise 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 <br />and states that the undersigned knows the Decedent and the surviving spouse of the <br />Decedent and that the following information is true and correct. <br />1. Name of Decedent: Merna C. Wold <br />Date of Death: September 20, 2021 <br />Domicile at Death: Dannebrog, Howard County, Nebraska <br />Name of Surviving Spouse: Paul A. Wold <br />Date of Marriage: July 25, 1970 <br />2. The Affiant is the attorney for the Decedent's spouse and, in that capacity, is <br />familiar with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska <br />estate tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lots One (1) and Two (2), Block Fourteen (14), Village of Cairo, Hall County, <br />Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $63,036.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. <br />FURTHER Affiant saith not. <br />11711-A44: <br />Denise D. Myers <br />Subscribed and sworn to before me this a q - day of December, 2021. <br />valpi.7ERAL NOTARY - stale of Nebraska <br />SUSAN R. MRKVICKA <br />My Comm. Exp. June 8, 2026 <br />Notary Public <br />rn <br />rn <br />N 4 <br />o y. <br />r) Z <br />CD <br />CD <br />N <br />O <br />