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STATE OF NEBRASKA COUNTY OF HALL AFFIDAVIT OF MARITAL STATUS ss. W o c) O rn = y � n = z rn CZ) x � v M D x = AFFIDAVIT OF MARITAL STATUS ss. W COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: George B. Dilla, Jr. Date of Death: November 28, 2004 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Garnette Dilla Date of Marriage: July 7, 1952. 2. The Afffant is related to the Decedent as follows: surviving spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to -wit: Lot Eight (8), in Block Nine (9), in Sheridan Place, being a part of Harrison's Subdivision of the Southwest Quarter of the Southeast Quarter (SW 1 /4SE1 /4) of Section Eight (8), Township Eleven (11) North, Range Nine (9), West of the 6th P.M., Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $54,012.00. 6. The Decedent and Afffant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77 -2102. FURTHER AFFIANT SAITH NOT. Garnette Dilla SUBSCRIBED and SWORN to before me this si day of December, 2004. GENERAL NOTARY • S'.zi! of i` &a5Ka &; GALEN E. S i EHLIK 4otaPublic �_ p. My Comm. Exp. ,May 1, 20M o c) O o r+ s rn CZ) rrT1 r i 2 r n v� co CD D N O C7) rl' o Z Cn p COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: George B. Dilla, Jr. Date of Death: November 28, 2004 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Garnette Dilla Date of Marriage: July 7, 1952. 2. The Afffant is related to the Decedent as follows: surviving spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to -wit: Lot Eight (8), in Block Nine (9), in Sheridan Place, being a part of Harrison's Subdivision of the Southwest Quarter of the Southeast Quarter (SW 1 /4SE1 /4) of Section Eight (8), Township Eleven (11) North, Range Nine (9), West of the 6th P.M., Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $54,012.00. 6. The Decedent and Afffant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77 -2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77 -2102. FURTHER AFFIANT SAITH NOT. Garnette Dilla SUBSCRIBED and SWORN to before me this si day of December, 2004. GENERAL NOTARY • S'.zi! of i` &a5Ka &; GALEN E. S i EHLIK 4otaPublic �_ p. My Comm. Exp. ,May 1, 20M