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<br />AFFIDAVIT OF MARITAL STATUS
<br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned
<br />-----------knows the Decedent and the surviving spouse of the Decedent and that the following information
<br />is true and correct:
<br />1. Name of Decedent: BERNHARDT BOLTZ
<br />Date of Death: April 18, 1989 (Certified copy of Death Certificate attached)
<br />Domicile at Date of Death: Hall County Nebraska
<br />Name of Surviving Spouse: BERNINA MAUDE BOLTZ
<br />Date of Death of the Surviving Spouse: February 25,2006
<br />Date of Marriage: February 6,1937
<br />The Affiant is related to the Decedent as follows: Affiant is the son of the Decedent.
<br />2. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax.
<br />3. Title to the following described real estate is held by the Decedent and the surviving
<br />spouse of the Decedent in joint tenancy, to wit:
<br />The South Fifty Feet (S50') of the North One Hundred (NI00') feet of Lots One (1) and
<br />Two (2), in Block Two (2), Original Village of Doniphan, Hall County, Nebraska;
<br />
<br />The East Half of the Northeast Quarter of Section Eight (8), in Township Nine (9) North,
<br />Range Nine (9) West of the 6th P.M., Hall County, Nebraska, except Schafer Subdivision to Hall
<br />County, Nebraska; and
<br />
<br />The Northeast Quarter of the Northeast Quarter (NEl/4NEl/4) of Section Sixteen
<br />(16), Township Ten (10), North, Range 9, West of the 6th P.M., Hall County, Nebraska,
<br />excepting therefrom that part thereof conveyed to the County of Hall, by Deed recorded in Book
<br />37 at page 137, and also excepting therefrom that part thereof conveyed to the State of Nebraska,
<br />by Deed recorded in Book 69 at page 673, and also excepting therefrom that part thereof
<br />conveyed to Hall County by Deed recorded as Document No. 99108980 of the deed records of
<br />Hall County, Nebraska, and subject to easement in favor of the Platte Valley Public Power and
<br />Irrigation District, as recorded in Book "R" at page 583.
<br />4. As of date of death (4/18/1989), the real estate has a fair market value of $140,000.00.
<br />5. The Decedent and Affiant were married as of date of death. There is no Nebraska
<br />Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no
<br />Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77-2102.
<br />FURTHER Affiant saith not. f!., de ~
<br />
<br />RO~ltz
<br />
<br />SUBSCRIBED and sworn to before me on ~..... .Jj1 J ,,100 (g.
<br />
<br />~~.i&JBw~ '
<br />NO ARYPUBLI
<br />
<br />.Je.GENeRAl. NOTARY-StIlle 01 Nebrallcl
<br />DEBRA L KAl.KOWSIO
<br />My Comm. flip. DIe. 2', 2001
<br />NeLL, Form 535
<br />* 77-~OO:l
<br />
<br />JNJ JLRITANCt' TAX SL.:RILS
<br />t 2006 Nebraska State Bar i\ssociatioll
<br />
<br />Page I
<br />I~ev 4106
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