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STATE OF NEBRASKA <br />� CC <br />COUNTY OF HALL ) �v <br />COMES NOW, the undersigned, being first duly sworn upon oath, and <br />deposes and states that the undersigned knows the Decedent and the surviving <br />spouse of the Decedent and that the following information is true and correct. <br />1 . Name of Decedent: Raymond C. Oltman <br />Date of Death: April 30, 2002 <br />Domicile at Death: Cairo, Hall County, Nebraska <br />Name of Surviving Spouse: Jean M. Oltman <br />Date of Marriage: August 8, 1945 <br />2. The Affiant is the daughter of the Decedent and, in that capacity, is <br />familiar with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or <br />Nebraska estate tax due. <br />4. Title to the following described real estate is held by the Decedent and <br />the surviving spouse in joint tenancy, to -wit: <br />South Seventy Feet (S 70') of Lot Two (2), Block One (1), Cairo Mayfield <br />Village 8th Addition, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of <br />$90.612.00. <br />6. The Decedent and the surviving spouse were married as of the date of <br />death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised <br />Statute §77 -2003. There is no Nebraska estate tax lien by reason of Nebraska <br />Revised Statute §77 -2102. <br />7. This Corrective Affidavit is being filed to replace the incorrect death <br />certificate filed with the original one. <br />FURTHER Affiant saith not. <br />Cheryl K. romer, now known as <br />Cheryl K. Larsen <br />SUBSCRIBED and sworn to before me phli- 9 day f June, 2004. <br />GENERAL <br />NOTARY- � State of Nebraska <br />DENISE Notary Public <br />My Comm. t� f a <br />70 <br />n C) <br />��,, <br />rn <br />T <br />f� <br />O to <br />M <br />� <br />n i <br />(D <br />= <br />n <br />v <br />7e <br />o <br />C) cn <br />o <br />M <br />rn <br />D <br />--a m <br />° <br />(�D <br />�l <br />-< C <br />CD <br />CL <br />-Ti <br />O <br />CD <br />cn <br />Q <br />4w <br />� <br />CD <br />200405828 <br />N <br />CD <br />v <br />C.0 <br />q0 <br />CORRECTIVE <br />CP <br />AFFIDANPT <br />OF MARITAL STATUS <br />STATE OF NEBRASKA <br />� CC <br />COUNTY OF HALL ) �v <br />COMES NOW, the undersigned, being first duly sworn upon oath, and <br />deposes and states that the undersigned knows the Decedent and the surviving <br />spouse of the Decedent and that the following information is true and correct. <br />1 . Name of Decedent: Raymond C. Oltman <br />Date of Death: April 30, 2002 <br />Domicile at Death: Cairo, Hall County, Nebraska <br />Name of Surviving Spouse: Jean M. Oltman <br />Date of Marriage: August 8, 1945 <br />2. The Affiant is the daughter of the Decedent and, in that capacity, is <br />familiar with the marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or <br />Nebraska estate tax due. <br />4. Title to the following described real estate is held by the Decedent and <br />the surviving spouse in joint tenancy, to -wit: <br />South Seventy Feet (S 70') of Lot Two (2), Block One (1), Cairo Mayfield <br />Village 8th Addition, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of <br />$90.612.00. <br />6. The Decedent and the surviving spouse were married as of the date of <br />death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised <br />Statute §77 -2003. There is no Nebraska estate tax lien by reason of Nebraska <br />Revised Statute §77 -2102. <br />7. This Corrective Affidavit is being filed to replace the incorrect death <br />certificate filed with the original one. <br />FURTHER Affiant saith not. <br />Cheryl K. romer, now known as <br />Cheryl K. Larsen <br />SUBSCRIBED and sworn to before me phli- 9 day f June, 2004. <br />GENERAL <br />NOTARY- � State of Nebraska <br />DENISE Notary Public <br />My Comm. t� f a <br />