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COMES NOW, the undersigned, being first duly sworn upon oath,
<br />and deposes and states that the undersigned knows the Decedent, and
<br />the surviving spouse of the Decedent and that the following �N
<br />information is true and correct. b
<br />1. Name of Decedent: Zella Francis Klinkacek
<br />Date of Death: October 18, 2001
<br />Domicile at Death: Cairo, Hall County, Nebraska
<br />Name of Surviving Spouse: Lester Klinkacek
<br />Date of Marriage: June 16, 1949
<br />2. The Affiant is the daughter of the Decedent arid, in that
<br />capacity, is familiar with the marital status and the death of the
<br />Decedent.
<br />3. That there is no federal estate tax, Nebraska inheritance
<br />tax or Nebraska estate tax due.
<br />4. Title to the following described real estate is held by
<br />the Decedent and the surviving spouse in joint tenancy, to -wit:
<br />- ,_e S {.utl- Ninety (90.0" feet of the West One Hundred
<br />Thirty -one and five tenths (131.5) feet of Lot One (1),
<br />Block One (1), Ingalls Turner Subdivision, Cairo, Hall,
<br />County, Nebraska, and the North Twenty -three (23.0) feet
<br />of the South One Hundred Thirteen (113.0) feet of the
<br />West One Hundred Thirty -one and five tenths (131.5) feet
<br />of Lot One (1), Block One (1), Ingalls Turner
<br />Subdivision, Cairo, Hall County, Nebraska.
<br />5. As of the date of death, the real estate had a fair market
<br />value of $73,920.00.
<br />6. The Decedent and the surviving spouse were married as of
<br />the date of death. There is no Nebraska inheritance tax lien by
<br />reason of Nebraska Revised Statute X77 -2003. There is no Nebraska
<br />estate tax lien by reason of Nebraska Revised Statute §77 -2102.
<br />2001.
<br />FURTHER Affiant saith not.
<br />s
<br />Patricia Ann Hill
<br />(111
<br />Subscribed and sworn to before me this _,2C2— day of November,
<br />�AIXY•P&
<br />oe •. •.�� otary Public
<br />2 MAUREEN P
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<br />COMES NOW, the undersigned, being first duly sworn upon oath,
<br />and deposes and states that the undersigned knows the Decedent, and
<br />the surviving spouse of the Decedent and that the following �N
<br />information is true and correct. b
<br />1. Name of Decedent: Zella Francis Klinkacek
<br />Date of Death: October 18, 2001
<br />Domicile at Death: Cairo, Hall County, Nebraska
<br />Name of Surviving Spouse: Lester Klinkacek
<br />Date of Marriage: June 16, 1949
<br />2. The Affiant is the daughter of the Decedent arid, in that
<br />capacity, is familiar with the marital status and the death of the
<br />Decedent.
<br />3. That there is no federal estate tax, Nebraska inheritance
<br />tax or Nebraska estate tax due.
<br />4. Title to the following described real estate is held by
<br />the Decedent and the surviving spouse in joint tenancy, to -wit:
<br />- ,_e S {.utl- Ninety (90.0" feet of the West One Hundred
<br />Thirty -one and five tenths (131.5) feet of Lot One (1),
<br />Block One (1), Ingalls Turner Subdivision, Cairo, Hall,
<br />County, Nebraska, and the North Twenty -three (23.0) feet
<br />of the South One Hundred Thirteen (113.0) feet of the
<br />West One Hundred Thirty -one and five tenths (131.5) feet
<br />of Lot One (1), Block One (1), Ingalls Turner
<br />Subdivision, Cairo, Hall County, Nebraska.
<br />5. As of the date of death, the real estate had a fair market
<br />value of $73,920.00.
<br />6. The Decedent and the surviving spouse were married as of
<br />the date of death. There is no Nebraska inheritance tax lien by
<br />reason of Nebraska Revised Statute X77 -2003. There is no Nebraska
<br />estate tax lien by reason of Nebraska Revised Statute §77 -2102.
<br />2001.
<br />FURTHER Affiant saith not.
<br />s
<br />Patricia Ann Hill
<br />(111
<br />Subscribed and sworn to before me this _,2C2— day of November,
<br />�AIXY•P&
<br />oe •. •.�� otary Public
<br />2 MAUREEN P
<br />;TEICHMANN;
<br />9 OF Co`��P
<br />
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