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<br /> BTATE OF NEBRASKA )
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<br /> - COUNTY OF HALL )
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<br /> ' �' CoMES NOW, the underaigned, being duly aworn, deposes and --- -
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<br /> r� sta�es that the following inPormation ie true and aorreat: -
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<br /> 1. Name of Deaedent: Mary E. Evans
<br /> ,�:1�:�•'.�. Data oP Deat.tis Febxuaxy 22, 1994
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<br />_-- -,`���;.__..__��-- �iomiaile at �i��a fiP Bna�ui G�and Is2and, :is12 County, _
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<br /> � Nebraska
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<br /> -�� ��: Name of Surviving spouse s Laurencse E. Evans
<br /> !'�:° , '� a.;�" Date of Marriage: September 26, 1988
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<br /> �� e 2. The Affiant 3s the Deaedent�s surviving spouee. -�
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<br /> - � 3. There is no Federal Estate Tax, Nebraska inher tance iax a
<br /> . or Nebraska Estato Tax. �_�
<br /> ° 4. Title to the following described real estate is held by �,Y:�;a
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<br /> the Decedent and the surviving apouse of the Decedent in joint _�.
<br /> f.. . tenanay, to-wit s �;�`�:
<br /> Lot Seventeen (17j , Block Three (3) , Normandy Eatates, Grand �
<br /> j _ ., Island, Nebraska; and
<br /> ' , The North Forty-Four Feet (44') of Lots Nine (9) and Ten (10) ,
<br /> . Block Twenty-One (21) , Schimmer's Addition, Grand Island,
<br /> - � � Nebraska. �
<br /> � � � ,.
<br /> � 5. Aa of the date of death, the real estate has a fair market �
<br /> „ . , value of $82,460.00 (i.e. Normandy Estates - $51,830.00; Schimmer's
<br /> , Addition - $30,620.00) .
<br /> " 6. The Decedent and Affi.ant were married as of the date of
<br /> � ` death. There is no Nebraska Inheritance Tax lien by reason of
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