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Return to: Galen E. Stehlik P.O. Box 400 Grand Island, NE 68802-0400 INST 1013 0U131 AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ) ) ss. COUNTY OF HALL ) CASH CHECK /(o -a) REFUNDS: CASH CHECK HALL _,t Ni 1013': 5I VIOLD REGISTER COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Phyllis Arlene Swanson Date of Death: March 24, 2020 Domicile at Date of Death: Grand Island, Hall County, Nebraska Name of Surviving Spouse: Ben J. Swanson Date of Marriage: September 14, 1952 2. The Affiant is related to the Decedent as follows: Surviving Spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is currently held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to -wit: Lot Four (4), of Sunset Seventh Subdivision, being a part of the Northeast Quarter (NE 1/4) of Section Eleven (11), Township Eleven (11) North, Range Ten (10), West of the 6th P.M., in Hall County, Nebraska. Ate co 5. As of the date of death, the real estate has a fair market value of $302,561 (assessed adjusted to fair market value) 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77-2102. FURTHER AFFIANT SAITH NOT. oCi/P'V* Ben J. Swanson SUBSCRIBED and SWORN to before me this I( day of August, 2023. .404(1EINS3AL NOTARY - ate of Nebraska GALEN STEHUK My Comm. Exp. May 1, 2028