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1 . 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 <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 describQd real estate is held by the Decedent and <br />the surviving spouse in joint tenancy, to -wit: <br />The West Sixty Feet (W60') of Lots One (1) and Three (3), 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 <br />$43,991.00. <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 an inaccurate legal <br />description. <br />FURTHER Affiant saith not. <br />Delmar C. Hood <br />Subscribed and sworn to before me this i day of July, 2004. <br />REBA BELIE STACY <br />N Comm. # 1411818 <br />NOTARY PUBLIC -CALIFORNIA �) Notar Public <br />San Diego Camly <br />My Comm. Expires Llarch13,m <br />r <br />;0 0 n <br />M <br />C rn cAis <br />n = �� <br />m <br />>K. Z 4 <br />rV <br />m <br />�1 <br />n CA C_ <br />�. 7C 2� r m <br />O <br />C. <br />> <br />o <br />. N o <br />© <br />CD <br />- <br />X z rn 00 Z <br />s <br />i� <br />m r- D <br />­3 <br />Cn <br />N <br />a <br />Crn <br />m <br />co 4n <br />Cn <br />rt <br />t!7 <br />z <br />CORRECTIVE <br />AFFIDAVIT OF MARITAL STATUS <br />200407455 <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL <br />0 <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: 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 <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 describQd real estate is held by the Decedent and <br />the surviving spouse in joint tenancy, to -wit: <br />The West Sixty Feet (W60') of Lots One (1) and Three (3), 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 <br />$43,991.00. <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 an inaccurate legal <br />description. <br />FURTHER Affiant saith not. <br />Delmar C. Hood <br />Subscribed and sworn to before me this i day of July, 2004. <br />REBA BELIE STACY <br />N Comm. # 1411818 <br />NOTARY PUBLIC -CALIFORNIA �) Notar Public <br />San Diego Camly <br />My Comm. Expires Llarch13,m <br />r <br />