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;70 n ~ o~ m ::I: :~-.~ ." C m en (~ 0 (Ii e;) <:::;::::) Z n ::c '~~ -.:I C> -j j:) n A c: >- f'Va. :z: E 0 :D z -1 ;.- rn ~ :;Q ~, '- -0 -1 m '1 n :--.. n'1 'l- ::0 -< ~Gr ~-) f" '-- c> l\.) 1';; :I: o<~ 0 '1 CSl (I) CD ..." ~S- "'r] .....,... 0 -t- '"'h....f -.....J S- \) c r ,~,~~ ri"") og CSl rrT -0 ~ ClJ l\.) - n1 :3 r ;J;J OJ '=' r J> ~i 0 n- (j) f-lo (jJ .p. rv ~ )> C'...) -- CD (f) -cZ (f) 0 AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ) ) ss. ) .....0 /0' ~ COUNTY OF HALL COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Louise 1. Barg Date of Death: March 20,2007 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Arthur W. Barg Date of Marriage: February 11, 1935 2. The Affiant is related to the Decedent as follows: survivmg spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to thc following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to-wit: Lot Seven (7), Block Three (3), Bel Air Addition to the City of Grand Island, Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of$100,500.00. 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77-2102. FURTHER AFFIANT SAITH NOT. ~ tv, 13/ Arthur W. Barg , ~I JL.' <D and SWORN to before me this-' day of 'pn J ,2007. GENERAl. NOTARY. State of Nebrask,\ I' -, SHERRY SASGES ' M/) Comm. ._42008' \"j'UILf.L.t .( ,,'),1 (J Ai j.e.-4/ N~tary Public I' "