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CASH CHECK 1(0 90 REFUNDS: CASH CHECK RECORDED HALL COUNTY NE 1NST 2023 0 Li 1 3 1 2023 SEP 12 A 11: 18 KRISTi WOLD REGISTER OF DEEDS Return to: Jamie Mues Jankovitz )(17 308 N. Locust St., Ste. 400 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 she is the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Hobart E. Lemburg Date of Death: January 11, 2002 Domicile at Death: 41 Blue Jay, Alda, Nebraska Name of Surviving Spouse: Karla Lemburg Date of Marriage: October 11, 1980 2. The Affiant is the surviving spouse 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 12, Block 1 in Dodd and Marshall's Addition to the Town of Wood RiverHA.1 Countv,Nebraska, andA certaAumt-ect tract of land Thirty:tliitt-fe4 akot-iiiig 'the- tag .§idtdftat. Twelve .(I2); Block One (1), Dodd and Marshall's Addition to the Village of Wood River, Nebraska., described as follows: Commencing at the Northeast Corner of Lot 12, thence South on the East line of Lot 12, a distance of 75 feet, then East on the South Line of Lot 12 extended a distance of 33 feet, thence North on a line parallel to the East line of Lot 12, a distance of 75 Feet, thence West a distance of 33 feet to the point of beginning. (FYI: aka: 1312 Walnut St., Wood River, Nebraska.) 5. As of the date of death, the real estate had a fair market value of: per Hall County Assessor -$36,304.00 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 SUBSCRIBED and sworn to before by Karla Lemburg, Affiant. PREPARED BY: Jamie Mues Jank BRADLEY LAW OFFICE, PC 3OC N. Locust St., Ste 400 Grand Island, NE 68861 Telephone: (308) 382-2128 jamie@bradleylawollice,com GENERAL NOTARY • State of Nebraska JAMIE MUES JANKOVITZ My Comm. Exp. May 25,2026 a a: Lemberg, Page 1 of 1