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�A STATE OF NEBRASKA O COUNTY OF HALL m � C\ rT ! n' M � N N AFFIDAVIT OF MARITAL STATUS ss. O co N O —i c 3> m r- �o N O T x m D � � r � r a co 7K D C.3 "i v F— [!> rn 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: Everett E. Randall Date of Death: June 15, 2002 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Zola G. Randall Date of Marriage: August 1, 1942. 2. The Affiant is the Decedent's 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 THIRTEEN (13), SOUTH 2338 FEET OF LOT ELEVEN (11), BLOCK TWELVE (12) UNIVERSITY PLACE, GRAND ISLAND, HALL COUNTY, NEBRASKA. 5. As of the date of death, the real estate has a fair market value of approximately $60,805.00 (assessed value). 6. The Decedent and Affiant were married as of June 15, 2002, the Decedent's 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. Z0 . Randall Subscribed and sworn to before me this Ra day of July, 2002. NOTARY • state of Nebraska OALEN E. STEHLIK Conn. E�. May t, 2008 N ary Public ESTATES \RANDALL.AFF .7 N YT1 o co CD O CD Ea N Q" O y 1) V �S co � J [D ca 0 7 n n z v ¢ rTi N N �n a V� q 0. �A STATE OF NEBRASKA O COUNTY OF HALL m � C\ rT ! n' M � N N AFFIDAVIT OF MARITAL STATUS ss. O co N O —i c 3> m r- �o N O T x m D � � r � r a co 7K D C.3 "i v F— [!> rn 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: Everett E. Randall Date of Death: June 15, 2002 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Zola G. Randall Date of Marriage: August 1, 1942. 2. The Affiant is the Decedent's 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 THIRTEEN (13), SOUTH 2338 FEET OF LOT ELEVEN (11), BLOCK TWELVE (12) UNIVERSITY PLACE, GRAND ISLAND, HALL COUNTY, NEBRASKA. 5. As of the date of death, the real estate has a fair market value of approximately $60,805.00 (assessed value). 6. The Decedent and Affiant were married as of June 15, 2002, the Decedent's 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. Z0 . Randall Subscribed and sworn to before me this Ra day of July, 2002. NOTARY • state of Nebraska OALEN E. STEHLIK Conn. E�. May t, 2008 N ary Public ESTATES \RANDALL.AFF .7 N YT1 o co CD O CD Ea N Q" O y 1) V �S co � J [D ca 0 7