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STATE OF NEBRASKA ? ) ss: COUNTY OF HALL ) COMES NOW the undersigned, being duly sworn, deposes and /v,.S o says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Emil Rudolf Mangelsen Date of Death: February 14, 2005 Domicile at Date of Death: Grand Island, NE Name of Surviving Spouse: Helen Elsie Mangelsen Date of Marriage: January 3,1955 2. The Affiant is related to the Decedent as follows: Spouse 3. There is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the real estate, as set forth below, is held by the Decedent and the surviving spouse of the Decedent in joint tenancy: LOT 7 BLOCK 76 OF WHEELER AND BENNETT'S 3"" ADDITION TO THE CITY OF GRAND ISLAND, HALL COUNTY, NEBRASKA. 5. As of the date of death, the real estate has a fair market value of: $64,431.00 6. The Decedent and Affiant were married as of the 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. Helen Elsie Mang lsdfn, Affiant C:) ry rn CA � 71 n C!l CTI Ma CTI to C �' W -- """� -- ° - p 7c C,, �. C r 200502536 AFB ID WIT OF MARITAL STATUS STATE OF NEBRASKA ? ) ss: COUNTY OF HALL ) COMES NOW the undersigned, being duly sworn, deposes and /v,.S o says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Emil Rudolf Mangelsen Date of Death: February 14, 2005 Domicile at Date of Death: Grand Island, NE Name of Surviving Spouse: Helen Elsie Mangelsen Date of Marriage: January 3,1955 2. The Affiant is related to the Decedent as follows: Spouse 3. There is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the real estate, as set forth below, is held by the Decedent and the surviving spouse of the Decedent in joint tenancy: LOT 7 BLOCK 76 OF WHEELER AND BENNETT'S 3"" ADDITION TO THE CITY OF GRAND ISLAND, HALL COUNTY, NEBRASKA. 5. As of the date of death, the real estate has a fair market value of: $64,431.00 6. The Decedent and Affiant were married as of the 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. Helen Elsie Mang lsdfn, Affiant