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CASH <br />G��� CHECK / .. <br />1..Z.Z. ,4 7 <br />REFUNDS: <br />CASH <br />Iv CHECK <br />w 1/4.%RECORDED <br />m HALL COU'R IY NE <br />°o -%.1 <br />IS1 IST 2023 0 b 0 3 8 ZOZ3 NOV I b A 11: 2b <br />K RISTI WOLD <br />REGISTER OF DEEDS <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />COUNTY OF HALL <br />ss: <br />/o -o° <br />The undersigned, being duly sworn, deposes and says that the <br />undersigned is the Attorney for the estate of the Decedent and <br />that the following information is true and correct: <br />1. Name of Decedent: Reva J. O'Brien <br />Date of Death: 09/10/23 <br />Domicile at Date of Death: Grand Island, Nebraska <br />Name of Surviving Spouse: James H. O'Brien <br />Date of Marriage: 05/27/1975 <br />2. The Affiant is related to the Decedent as follows: <br />Attorney for the heir of the Decedent. <br />3. There is no federal estate tax, Nebraska inheritance tax <br />or Nebraska estate tax due. <br />4. Title to the real estate, as set forth below, is held by <br />the Decedent and the surviving spouse of the Decedent in joint <br />tenancy: <br />The North 9 Feet of Lot 3 and the South 46 Feet of Lot 1, <br />Block 22, Scarff's Addition to West Lawn, City of Grand <br />Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair <br />market value of $139,354.00. <br />6. The Decedent and Affiant were married as of the date of <br />