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<br />AFFIDAVIT OF MARITAL STATUS
<br />
<br />STATE OF NEBRASKA )
<br />) ss.
<br />COUNTY OF HALL )
<br />
<br />// rfJ
<br />
<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 />
<br />1. Name of Decedent: Alan J. Hoffman
<br />Date of Death: July 7, 2006
<br />Domicile at Death: Grand Island, Hall County, Nebraska
<br />Name of Surviving Spouse: Kaylene G. Hoffman
<br />Date of Marriage: October 3, 1970
<br />
<br />2. The Affiant is the daughter of the Decedent and, in that capacity, is familiar with
<br />the marital status and the death of the Decedent.
<br />
<br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate
<br />tax due.
<br />
<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 />
<br />Lots Thirteen (13) and Fifteen (15), Block Fifteen (15), University Place, an
<br />Addition to the City of Grand Island, Hall County, Nebraska.
<br />
<br />5. As of the date of death, the real estate had a fair market value of $99,287.00.
<br />
<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 fj77-
<br />2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute fj77-
<br />2102.
<br />
<br />FURTHER Affiant saith not.
<br />
<br />~,~~
<br />" ennif L. eit chuck
<br />
<br />Subscribed and sworn to before me this db day of September, 2006.
<br />
<br />~lLt [J. LJiuI
<br />otary ublic
<br />
<br />.;'._'::~-~'~:.',';',~~~~~~.,~~~~~...:..., .
<br /><i:;;;::it:." WAYNE A WEST ~
<br />ll' e~;;;;R~~):} MY COMMISSION EXPIRES "
<br />',' ',.~'t".;.~";;,,, December 22. 2006
<br />
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