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<br />AFFIDAVIT OF MARITAL STATUS
<br />
<br />STATE OF NEBRASKA )
<br />) ss.
<br />COUNTY OF HALL )
<br />
<br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and ;0.5"'0
<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: Virginia L. Haynes
<br />Date of Death: October 31,2006
<br />Domicile at Death: Cairo, Hall County, Nebraska
<br />Name of Surviving Spouse: Wade J. Haynes
<br />Date of Marriage: June 12, 1954
<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 />The West Half of the Southeast Quarter (W1/2SE1/4) of Section Twenty-
<br />Four (24), Township Twelve (12) North, Range Twelve (12), West of the 6th
<br />P.M., Hall County, Nebraska, excepting therefrom that certain tract of land
<br />conveyed by Warranty Deed dated March 31, 1983, and recorded as
<br />Document No. 93102584 on April 6, 1993, with the Hall County Register of
<br />Deeds, and excepting therefrom that certain tract of land conveyed by
<br />Warranty Deed dated February 24,2000, and recorded as Document No.
<br />200001596 on February 28, 2000, with the Hall County Register of Deeds.
<br />Said tract contains 10.001 acres, more or less.
<br />
<br />5. As of the date of death, the real estate had a fair market value of $122,849.00.
<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 />~a~~~
<br />
<br />
<br />8ENEIW. NOlM'f.......
<br />DENI8I 0. MYEA8
<br />My Convn. EIp. III zo. 2010
<br />
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