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202205989
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Last modified
8/15/2022 3:06:09 PM
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8/15/2022 3:06:09 PM
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202205989
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m ZD <br />m� <br />C r12 <br />Z <br />n=•' <br />Return to: Jamie Mues Jankovitz ✓tiew <br />202 W. 3rd St. <br />Grand Island, NE 68801 <br />AFFIDAVIT OF MARITAL STATUS WITH DEATH CERTIFICATE <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that <br />the undersigned knows the Decedent and the surviving spouse of the Decedent and that the <br />following information is true and correct. <br />1. Name of Decedent: Tracy G. Miller <br />Date of Death: June 15, 2022 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Kevin L. Miller <br />Date of Marriage: November 22, 1986 <br />2. The Affiant is the husband of the Decedent and in that capacity is familiar <br />with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />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 Eighteen (18), in Block Sixteen (16), in Ashton Place, an <br />Addition to the City of Grand Island, Hall County, Nebraska. <br />(Physical Address: 2704 W. Koenig St, Grand Island, NE) <br />5. As of the date of death, the real estate had an assessed value of $91,693.00. <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 <br />Statute § 77-2003. There is no Nebraska estate tax lien by reason of Nebraska <br />Revised Statute §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />Kevin L. iller, Affiant <br />SUBSCRIBED and sworn to before me on this day of <br />Kevin L. Miller, Affiant. <br />-GENERAL NOTMY -Mate of Nebraska <br />JAMIE MUES JANKOVITZ <br />eAt I. My Comm. Exp. May 25,2028 <br />PREPARED BY: <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY LAW OFFICE, PC <br />202 West Third Street <br />Grand Island, NE 68801 <br />Telephone: (308) 382-2128 <br />j amie@bradleylawofficed.com <br />, 2022 by <br />rim <br />r.; .1'7.1 <br />m <br />) <br />cn Z <br />c.n <br />co -i <br />co Crri <br />110.0 <br />Page 1 of 1 <br />
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