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030 <br />—4 <br />G) <br />CO <br />Return to: <br />Galen E. Stehlik <br />P.O. Box 400 <br />Grand Island, NE 68802-0400 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1 Name of Decedent: Orville Dean Garrett <br />Date of Death: September 3, 2021 <br />Domicile at Date of Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Marjorie I. Garrett <br />Date of Marriage: September 30, 1953 <br />2. The Affiant is related to the Decedent as follows: Surviving Spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due <br />because of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to -wit: <br />See Attached. <br />5. As of the date of death, the real estate has a fair market value of $161,785.56 (assessed adjusted to <br />fair market value). <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77-2102. <br />FURTHER AFFIANT SAITH NOT. <br />SUBSCRIBED and SWORN to before me this ( day of <br />GENERAL NOTARY - State of Nebraska <br />GALEN E. STEHLIK <br />My Comm. Exp. May 1, 2022 <br />, 2022. <br />Notarv'Public <br />