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~~~~~ " nn ,0 m :.t:)>- ~~~. ~ -n m c.n C n:J: Z ,""'-> n '" <:..'"::> (")(fJ /Tl N l"'\ ~. nO <::::> X ~~ ~ 0...... "C) ::J cs ~ ," ITI >~ c::> f'\)fij s Ei' ~ ," 0) ,. .~ ....... nc.n c= z...... am s ~ ~ ~::I: Z -t1Tl CJl -<0 C- O) ~ iA N 0"" ~~ 0) lV " "Tl en ""z -->. ~r ::!: n'l 5" ::0 :t>- cu a .3 r :::0 ~ r- 'l>- Ul 2 ~ (I) en Q :;:><; 3 :t>- en .........- 0') a. AFFIDAVIT OF MARITAL STATUS en (/) ........ --- en ~ STATE OF NEBRASKA ) 200605661 ) ss. COUNTY OF HALL ) "I t) .'::;-0 COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Johnny Taylor Date of Death: March 21,2006 Domicile at Death: Grand Island, Hall County, Nebraska Name of Surviving Spouse: Joyce A. Taylor Date of Marriage: December 28, 1996 2. The Affiant is the sister-in-law of the Decedent and, in that capacity, is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to-wit: Lot Six (6), Block Four (4), Gilbert Subdivision to the City of Grand Island, Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $76,081.00. l 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien.. by reason of Nebraska Revised Statute fJ77- 2003. There is no Nebraska estate tax lien ~reason of Nebraska Revised Statute fJ77- 2102. FURTHERAffiantsaithnot. ~.JI'L~ ~;.ktA-~) ~- Stolt berg-Humiston \) Subscribed and sworn to before me thi&ll~day of June, 2006. .ftUl GENM. M)1'Aft't . Sl8t8 of Nebraska I DIANE M, BYKERK My COmm. Exp." 1, 200'1