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Return to: Jamie Mues Jankovitz 202 W. 3rd St. Grand Island, NE 68801 AFFIDAVIT OF MARITAL STATUS WITH DEATH CERTIFICATE Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following information is true and correct. r,� i 1. Name of Decedent: Michael A. Palu Date of Death: June 4, 2022 Domicile at Death: Hall County, Nebraska Name of Surviving Spouse: Valerie K. Palu Date of Marriage: June 10, 1979 2. The Affiant is the wife of the Decedent and in that capacity is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to wit: Lot One (1), in Sunset 5th Subdivision in the City of Grand Island, Hall County, Nebraska 5. As of the date of death, the real estate had an assessed value of: $165,641.00 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. FURTHER THIS AFFIANT SAYETH NOT. STATE OF NEBRASKA ) ss: COUNTY OF HALL cit.tk,4 (4)(Lt Valerie K. Palu, Affiant SUBSCRIBED and sworn to before me on this Valerie K. Palu, Affiant. GENERAL NOTARY • State of Nebraska JAMIE MUES JANKOVITZ , My Comm. Exp. May 25, 2026 PREPARED BY: Jamie Mues Jankovitz, #20754 BRADLEY LAW OFFICE, PC 202 West Third Street Grand Island, NE 68801 Telephone: (308) 382-2128 jamieAbradleylawofce. com day of , 2022 by (J-1 (ID Page 1 of 2