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w <br />Return to: / Denise D. Myers <br />/ P.O. Box 505 <br />Y Cairo, NE 68824 <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states <br />that 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: Raymond J. Michalski <br />Date of Death: July 20, 2022 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Sharon L. Michalski <br />Date of Marriage: April 8, 1964 <br />2. The Affiant is the Decedent's spouse and, in that capacity, is familiar with the marital <br />status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax <br />due. <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to -wit: <br />The Westerly Sixty -Eight Feet (68') of Lot Ten (10) and the Easterly Six Feet (6') <br />of Lot Nine (9), all in Block One (1), of the Pleasant View Fourth Addition to the <br />City of Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $184,039.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. There <br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77-2003. <br />FURTHER Affiant sayeth not. <br />a <br />Sharon L. Michalski <br />Subscribed and sworn to before me this lD -741 <br />day ofd it , 2022. <br />GENERAL NOTARY • State of Nebraska <br />DENISE 0. MYERS <br />My Comm. Exp. November 20, 2022 <br />Notary Public <br />it, 6D <br />ON 1NNISISN1 Sd 031131143 <br />