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n <br />,_., <br />�� Yr <br />D <br />V <br />2 <br />m <br />� <br />C <br />n <br />,_., <br />E <br />D <br />2 <br />m <br />> Z <br />x <br />= v <br />rn CA <br />n <br />,_., <br />D <br />fJ? <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) 200307623 <br />) ss. <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, Ronald D. Emken, being duly sworn, deposes <br />and says that the undersigned knows the Decedent and that he is the surviving spouse of <br />the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Nancy Joann Emken <br />Date of Death: June 1, 2003 <br />Domicile at Date of Death: Hall County, Nebraska <br />Date of Marriage: December 5, 1966 <br />2. The Affiant is related to the Decedent as follows: Surviving Spouse of Decedent <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse of the Decedent, in joint tenancy, to wit: <br />Lot Twenty -Six (26), in Hidden Lakes Subdivision Number Four <br />(4), in the City of Grand Island, Hall County, Nebraska <br />5. As of date of death, the real estate has a fair market value of $158,000.00. <br />6. The Decedent and Ronald D. Emken were married as of date of death. There is <br />no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section <br />77 -2003. There is no Nebraska estate tax lien by reason of Nebraska Revised <br />Statutes Section 77 -2102. <br />FURTHER Affiant sayeth not. <br />Affiant, Ronald D. Emken <br />Subscribed and sworn to before me this &�, day of 2003. <br />w No ary Public <br />SHi]L4 BARBER <br />66,.- I�'dt2. <br />N <br />O <br />N fl. <br />CD <br />CD _ <br />CJ � <br />rN-i- <br />cD 2 <br />3 <br />p CD <br />N r"p <br />W 0 <br />v <br />