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m nn <br />• m� <br />rD Z <br />fl=/" <br />Return to: <br />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 />N <br />0 <br />N <br />N <br />CO <br />N <br />CD <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: James M. Shelton <br />Date of Death: March 8, 2011 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Edna J. Shelton <br />Date of Marriage: November 1, 1950 <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 />Lot Three (3) and Lot Four (4), in Block Six (6), "Country Club Subdivision", being <br />a part of the East Half of the Northwest Quarter (E1/2NW1/4) of Section Twenty -Eight <br />(28), in Township Eleven (11) North, Range Nine (9) West of the Sixth P.M., Hall County, <br />Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $105,388.00. <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 />Denise D. Myers <br />Subscribed and sworn to before me this <br />jimeGENEFIAL NOTARY • State of Nebraska <br />SUSAN R. MRKVICKA <br />My Comm. Exp..kne S, 2025 <br />S'+ <br />day of July, 2022. <br />�, rcic ;dce� <br />Notary Public <br />r1s1SN1 SIS 63H31N <br />