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j79£90ZZ0Z <br />rn <br />z <br />0 <br />n = N <br />' <br />rri <br />Return to: Law Office of Eurek & Peterson LLC, P 0 Box 310, Loup City, NE 688534 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) SS. <br />COUNTY OFSHERMAN ) <br />N <br />r' <br />0%'` <br />COMES NOW, the undersigned, being duly sworn, deposes and says that she is <br />the surviving spouse of the Decedent and that the following information is true and <br />correct: <br />1. Name of Decedent: Paul Earl Vierk <br />Date of Death: August 9, 2018, see Exhibit A for certified death certificate <br />Domicile at Date of Death: Cairo, Hall County, Nebraska <br />Name of Surviving Spouse: Jana R. Vierk <br />Date of Marriage: July 14, 1973 <br />The Affiant is related to the Decedent as follows: surviving spouse of the <br />Decedent. <br />2. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska <br />Estate Tax. <br />3. Title to the following described real estate is held by the Decedent and the <br />surviving spouse of the Decedent in joint tenancy, to -wit: <br />