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INST 1013 Oblb4 CASH CHECK /4' .4T) REFUNDS: CASH CHECK RECORDED HALL COUNTY NE 1013DEC 29 A'42 KRIS T 1 WOLD REGISTER OF DEEDS Return to: Michael P. Kneale / 2615 Riverview Dr. �/ 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 is the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Cheryl K. Harder Date of Death: December 8, 2023 Domicile at Death: Grand Island, Hall County, Nebraska Name of Surviving Spouse: Dennis W. Harder Date of Marriage: April 5, 1975 2. The Affiant is the 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: Legal Description: LOT TWENTY-THREE (23), MARYLANE SUBDIVSION, HALL COUNTY, NEBRASKA (Physical Address: 3941 Mary Lane, Grand Island, NE 68803) 5. As of the date of death, the real estate had an assessed value of $208,792.00. 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 ) Affiant SUBSCRIBED and sworn to before me on this 'day of Qenn�s hiarato , Affiant. PREPARED BY: Michael P. Kneale #19324 Telephone: (308) 379-1073 2615 Riverview Dr. Grand Island, NE 68801 Mike.kneale@charter.net by Notary Public Page 1 of 1