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<br /> ., ..L `t. �� . ,'�"' AFFIDAVIT OF MARITAL STATU8 "�-'�10232;;
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<br /> : �;^�,;,��: ' SYATE OF NEBRA3KA I
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<br /> � b: ���'� '. COUNTY OF .�►?,L... ... .... .. � � -- — --
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<br /> ,_ na�F,714�•:'�UC M��4�V�YwR��� � •.�:.� ..��{ ��:,
<br /> 17»/1a4�.�,..... ������.�IIfldY11�1Md���iM10(Q�d6p06YS����'J�1i1 ulY 011�8� : i.:�=-
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<br />•-�.t"�. , , . , arM y�wrvivinp spouce of tha Dscedent and that the following intamatio�i�tnro and coneal:
<br /> a'�'����• ... ...�� t. Nsma of Decsdent: ..Arle�e,O,.Np$s1?��ry►.. ..... .,... ..c.� ___
<br /> :_ .� •• �.=�D June 29, 1988
<br /> ;,. �mro a oaem: .... ... .............. ...... ....... ..... ..... _
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<br /> �;` .� .. a Domicile at Date ot OKth: �?��toL�,. .FryT�y7R�..GPUl1�Y•..Qhio
<br /> ��;:` • ` '�}:+;� Nu�of Survivin0 Spovsa: arqin,A,. Nussbaum ... _- - --
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<br /> _ u`'_�. Dat�of Marrip�: .. ... ...��.....�.'�:• •.. �
<br /> � unrelated,, brr�.,we11 ,aq�,�}�,�nted k. �.
<br /> , „ 2 TM AHiant is 7+slat�W tho Ooadant as fo1bwa: ... __---
<br /> . �. : , with Arlene.0._Hussbau�, and. Irvir►_A,.1�►�e��l�a.y�................ ==-- --
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<br /> _ 3. (X) Then b no F�deral EstaW Tax. Neb�acka Inhe�itence Tax a Nabra�ka Eetata Tax. �
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<br /> 4. TiNa to the fdloWlnp deuribed nal�stac�o�ea�eia��y the Decedent end tlw aouvivinp epausa of tho OeadenA ��it�.t;'`,,!. '
<br /> .. ° �.. in jant tenancy w wlt �r!,�;?��I��'�;J=
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<br /> :,. H,�.��,.0�.t�l�.I�4X'.th..E�al�..(.rJl./.2 Nl/2) ���,,�:;:u''- —_
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<br />` ' � . � ..o�..$�QC�G.�u. . 1�1..iri.kbB.F.Otl���l.�lddix.�Pn to the :.�����i�;`;if:.•:�
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<br /> � -� �•� ��- ' ..v�.1.lage .of..Caixe�....Hal.l..Caur�ty.,..Nekexaska ris � '�.
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<br /> •..,;;�iy • .� ' . S. Aa of date of death, the reel esia.e has a falr market valua of $..25.,.OQ9.... ... .... ............ .,�>i`v �'� -
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<br /> , '�:`'i� - 8, The Decedent and Affient were maRied as ot date of deatt�.l'here 1�no Nebraska Inheritanca Tax Ilen by ' , �r���f: .�,-_
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<br /> "•��'� � reason of Nebrasica iievised 3latutes Sectia++�%•�0�3.Thoro is no N�bvastca ostan tax Nen by reasaze�4 �,,.;:.!�-
<br /> '`�'•s��r �' ' . Nebraska Revised Stelutes Sectlon 77•210�2. ''tl' "`��—_
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<br /> ' FURTHER AHlant salth not. � -.
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<br /> t ���r,;;;i�'�I . AH�ant Claudia J. Obermiller � - . � _ �_
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<br />..;, ,'i�.l: . • ' Subscrfbed end sworn to before me thls .l J. ....... day o? ..�P►F�'�,�.............. . 199�... � �,_
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<br /> `.��:,;:; �, ��.• IAYIN6ALDWIN My commission expires .. . .. .. .. . ' . .� �•
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<br /> ��,r•;��, NCLE Fam 535 Pape 1 of 2 Pages I � .
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