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n <br />M <br />n <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />j ss. <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Dorothy Clara Gudgel <br />Date of Death: February 26, 2004 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Andrew J. Gudgei <br />Date of Marriage: April 26, 1980. <br />2. The Affiant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due <br />because of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse <br />of the Decedent in joint tenancy, to -wit: <br />Lot 16 in Block 1 except the Westerly 2 feet thereof in Knickrehm Third Addition to the <br />City of Grand Island, Hall County, Nebraska, subject to easements, covenants, <br />restrictions of record and public roads, if any. <br />5. As of the date of death, the real estate has a fair market value of $84,821.00. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance <br />Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien <br />by reason of Nebraska Revised Statutes Section 77 -2102. <br />FURTHER AFFIANT SAITH NOT. <br />Andrew J. Gudge <br />SUBSCRIBED and SWORN to before me this day of Ap ' 2004. <br />GENERA{- NOTARY - State of Nebraska <br />GALEN E. STEHUK tary Public <br />My Comm. Exp. May t, 2006 <br />= <br />D <br />n <br />C= <br />n <br />i <br />z <br />x <br />�. <br />-_ <br />° --q <br />o <br />0 <br />m <br />rn <br />C:) <br />� <br />O <br />O T <br />O <br />--. <br />C n <br />'*t Z <br />=3 <br />rn <br />2rn <br />b <br />3 <br />u' <br />f A <br />cn <br />W <br />CD <br />C a <br />W <br />0 <br />AFFIDAVIT OF <br />MARITAL STATUS <br />"' <br />j ss. <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Dorothy Clara Gudgel <br />Date of Death: February 26, 2004 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Andrew J. Gudgei <br />Date of Marriage: April 26, 1980. <br />2. The Affiant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due <br />because of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse <br />of the Decedent in joint tenancy, to -wit: <br />Lot 16 in Block 1 except the Westerly 2 feet thereof in Knickrehm Third Addition to the <br />City of Grand Island, Hall County, Nebraska, subject to easements, covenants, <br />restrictions of record and public roads, if any. <br />5. As of the date of death, the real estate has a fair market value of $84,821.00. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance <br />Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien <br />by reason of Nebraska Revised Statutes Section 77 -2102. <br />FURTHER AFFIANT SAITH NOT. <br />Andrew J. Gudge <br />SUBSCRIBED and SWORN to before me this day of Ap ' 2004. <br />GENERA{- NOTARY - State of Nebraska <br />GALEN E. STEHUK tary Public <br />My Comm. Exp. May t, 2006 <br />