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1 S 2023 03b11 <br />CASH <br />CHECK /60,i4 <br />RtFUNDS: <br />CASH <br />CHECK <br />HALL <br />*1 '.1r <br />2023 <br />EGIS EF; )F <br />Return to: Denise D. Myers <br />P.O. Box 505 <br />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: Robert L. Davis <br />Date of Death: June 18, 2023 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Adrianna K. Davis <br />Date of Marriage: June 29, 1975 <br />2. The Affiant is the attorney for the Decedent, 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 />Lot Twenty-two (22), Westroads Estates Fourth Subdivision to the City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $204,720. <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 />Denise D. Myers <br />Subscribed and sworn to before me this 1 ° day of , 2023. <br />GENERAL NOTARY • State of Nebraska <br />SUSAN R. MRKVICKA <br />_ My Comm. Exp. June 8, 2025 <br />-aem mr1Lu <br />Notary Public <br />