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COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Norman D.H. Bosselman <br />Date of Death: April 18, 2005 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Annetta M. Bosselman <br />Date of Marriage: January 19, 1942 <br />2. The Affiant is the son of the Decedent and, in that capacity, is familiar with the <br />marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lot Eleven (11), Block Five (5), Brentwood Subdivision, City of Grand Island, <br />Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $213,649.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. <br />is L. ossel M an <br />Subscribed and sworn to before meAlhisa-4ay of <br />2005. <br />ublic <br />GENERAL NOTARY - State of Nebraska <br />JEAN M. PETERSON <br />my Comm. . Se 18, 2008 <br />TJ <br />M <br />['1 <br />A <br />rn <br />CD <br />nn <br />v z <br />f�_ <br />e) a <br />I <br />fP <br />�r <br />ry <br />c� rn <br />ca <br />CD <br />S <br />-"r r„ <br />0 <br />r, <br />m <br />r- w <br />C <br />+ <br />r <br />P'V <br />� <br />C7 <br />to <br />l--� Z <br />to <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA <br />) <br />o <br />COUNTY OF <br />ss. <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />1. Name of Decedent: Norman D.H. Bosselman <br />Date of Death: April 18, 2005 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Annetta M. Bosselman <br />Date of Marriage: January 19, 1942 <br />2. The Affiant is the son of the Decedent and, in that capacity, is familiar with the <br />marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real estate is held by the Decedent and the <br />surviving spouse in joint tenancy, to -wit: <br />Lot Eleven (11), Block Five (5), Brentwood Subdivision, City of Grand Island, <br />Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $213,649.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. <br />is L. ossel M an <br />Subscribed and sworn to before meAlhisa-4ay of <br />2005. <br />ublic <br />GENERAL NOTARY - State of Nebraska <br />JEAN M. PETERSON <br />my Comm. . Se 18, 2008 <br />