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Retum to: <br />Kevin A. Brostrom <br />Lauritsen, Brownell & Brostrom, PC, LLO <br />1811 W. 2nd St., Ste 360 <br />Grand Island, NE 68803 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />rri <br />N r i <br />t/) <br />rso <br />co Cn <br />co rn <br />co <br />Apo <br />COMES NOW, the undersigned, being duly sworn, deposes and states that the undersigned <br />is the surviving spouse of the Decedent, and that the following information is true and correct: <br />1. Name of Decedent: Clifford A. Arnold also known as Clifford Arthur Arnold <br />Date of Death: April 13, 2022 <br />Domicile at Date of Death: Buffalo County, Nebraska <br />Date of Marriage: June 18, 1977 <br />2. The Affiant is the surviving spouse of the decedent. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax <br />that arose, or can arise, by virtue of the Decedent's death. <br />4. Title to the following described real estate was held by the Decedent and Bonnie <br />Arnold as joint tenants with rights of survivorship, the Decedent's spouse, on the date of the <br />Decedent's death, to -wit: <br />Villa No. Two (2) in Fairway Villas Condominium Property Regime I, City of <br />Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair market value of $200,105.00. <br />6. The Decedent and Affiant were married as of the date of death. There is no <br />Nebraska Inheritance Tax lien, by reason of Nebraska Revised Statute §77-2003. There is no <br />Nebraska Estate Tax lien by reason of Nebraska Revised Statute §77-2102. <br />FURTHER AFFIANT SAITH NOT. <br />Bonnie Arnold <br />Subscribed and sworn to before me this /149 -day of June, 2022. <br />23t44A4*? <br />P thli <br />GENERAL NOTARY - State of Nebraska <br />KEVIN A. BROSTROM <br />: My Comm. Exp. September 25, 2022 <br />