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CA`'' H <br />CHECK /(o •60 <br />REFUNDS: <br />�.� CASH <br />0� CHECK <br />N�� <br />liFf,; DE , <br />e� <br />WALL CC' ; t.,r NE <br />e <br />lNST 2073 0 0 3 3 0 2013 JAN ',..'3 f^; +I: 00 <br />viP"s r <br />, 0L.D <br />REGISTER O t <br />Return to: Jamie Mues Jankovitz <br />202 W. 3rd St. <br />Gand 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 the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />information is true and correct. <br />1. Name of Decedent: Jerome H. Brand <br />Date of Death: November 3, 2022 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Barbara M. Brand fka Barbara M. Sheffield <br />Date of Marriage: November 26, 2005 <br />2. The Affiant is the wife of the Decedent 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 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 />Unit Twenty Five (25), in Westwood Park 1 Condominiums, A <br />Condominium in the City of Grand Island, Hall County, Nebraska <br />5. As of the date of death, the real estate had an assessed value of: $246,335.00 <br />6. The Decedent and the surviving spouse were married as of the date of death. There is <br />no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. <br />There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />STATE OF NEBRASKA ) <br />ss: <br />Barbara M. Brand, Affiant <br />fka Barbara M. Sheffield <br />COUNTY OF HALL ) <br />SUBSCRIBED and sworn to before me on this 0./3gay of `7,g -c). , 2022 by <br />Barbara M. Brand, fka Barbara M. Sheffield, Affiant. `,/-� <br />r <br />(/ G GC.E,F- <br />94/m—fe-irt..-j-es_a <br />(/ Notary Public <br />GENERAL NOTARY - State of Nebraska <br />JAMIE MUES JANKOVITZ <br />My Comm. Exp. May 25, 2026 <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 />jamie(&,bradleylawo(ce. com <br />Page 1 of 2 <br />IV <br />