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I.Z£90£Z0Z <br />oTh -5D <br />0 <br />� c <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />INST 2023 0b321 <br />AFFIDAVIT OF MARITAL STATUS <br />ss: <br />CASH ` <br />CHECK Ar - <br />REFUNDS: -(o <br />REFUNDS: <br />CASH <br />CHECK <br />J <br />HALL NF <br />2023 CE -L = 12: 08 <br />VVOLD <br />REGISTER OF DEEDS <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: Khampheua Xayarath <br />Date of Death: February 24, 2022 <br />Domicile at Date of Death: Grand Island, Nebraska <br />Name of Surviving Spouse: Bountheng Xayarath <br />Date of Marriage: March 14, 1967 <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 />Lot 32, R & B Subdivision, City of Grand Island, Hall <br />County, Nebraska. <br />5. As of the date of death, the real estate has a fair <br />market value of $289,749.00. <br />6. The Decedent and Affiant were married as of the date of <br />death. There is no Nebraska inheritance tax lien by reason of <br />