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STATE OF NEBRASKA <br />COUNTY OF HALL <br />M <br />A <br />t; TTT <br />s <br />T <br />M CA <br />eb <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />) ss. <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent ot <br />and that the following information is true and correct. <br />Name of Decedent: Bell Jean Harders <br />Date of Death: May 18, 2004 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Raymond Harders <br />Date of Marriage: January 4, 1953 <br />2. The Affiant is the brother of the Decedent and, in that capacity, is familiar with <br />the marital status and the death of the 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 the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lot Three (3) and the West Sixty Feet (W 60') of Lot One (1), Block Fifteen <br />(15), Scarff s Addition to West Lawn, Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $43,991.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. ? <br />G 2�� <br />mar C. Hood <br />Subscribed and sworn to before me this L day of June, 2004. <br />Notary Public <br />6C"N CIMMM <br />MMSE o <br />Mr Ocmm. � <br />Ms <br />M <br />A <br />T <br />M CA <br />Z <br />v <br />., <br />M <br />_ <br />n <br />D <br />cn <br />C Cn <br />c n <br />C (D <br />rn <br />C1 <br />L <br />F—+ <br />p -Tl <br />O <br />'TT <br />co <br />'tl i <br />-C <br />T <br />rr <br />M <br />CD <br />~ <br />AFFIDAVIT OF MARITAL STATUS <br />C" <br />) ss. <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent ot <br />and that the following information is true and correct. <br />Name of Decedent: Bell Jean Harders <br />Date of Death: May 18, 2004 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Raymond Harders <br />Date of Marriage: January 4, 1953 <br />2. The Affiant is the brother of the Decedent and, in that capacity, is familiar with <br />the marital status and the death of the 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 the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lot Three (3) and the West Sixty Feet (W 60') of Lot One (1), Block Fifteen <br />(15), Scarff s Addition to West Lawn, Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $43,991.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. ? <br />G 2�� <br />mar C. Hood <br />Subscribed and sworn to before me this L day of June, 2004. <br />Notary Public <br />6C"N CIMMM <br />MMSE o <br />Mr Ocmm. � <br />Ms <br />