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<br />N <br />CSl <br />CSl <br />--J <br />CSl <br />N <br />Q:) <br />(JJ <br />....... <br /> <br />~~~ <br />~~~ <br />~W ~ <br />,,\ ~ <br />~~I':. <br />~ ~ ~ <br />~ ~ ';:r <br />~rt~ <br />In"'i ,- <br />~f <br />~~ <br />~t <br /> <br /> ;:10 C) (1 <br /> m :1': )to <br /> "'T1 <br /> C m . U'1. <br />i"l Z (') :l: <br /> """1+' <br />~ 0 ....., <br />::r: <br />ITI ~ <br />(') en <br />;.1'1; :r:: ~ <br /> lr\ <br /> 0 <br /> <br /> .'~.....",:!> I <br /> C:,",_"'lo (") C"\ 0 <br /> ~~ C> -, <br /> -.,l <br /> "'" c: J:.. N <br /> ...~,.....4.:,L.,., ::n z -, <br />-:::J ~'- -0 -~ rr, 0 <br />r,-1 ~('... ::::0 -< ,..-:, <br /><.""") ~- C) -" c:::> ~ <br />O'-.,~~ c..o -" .'-;r --J <br />." <br /> tC :::r: 1'''-1 - <br />C.J '\ J:CO- nJ c:::> ~ <br />rT' F\ --. -0 I :::0 <br />Pl ::3 N <br />0 ~ r- J:,.. <br />(j) ~ (j) CO <br /> W 7 i <br /> l> c..n <br /> c..n "-" "-" <br /> CO (f) ..--. <br /> (f) ~ <br /> <br />200702851 <br /> <br />AFFIDAVIT OF MARITAL STATUS <br /> <br />STATE OF NEBRASKA <br /> <br />) <br />) ss. <br />) <br /> <br />5,50 <br /> <br />COUNTY OF HALL <br /> <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Frank W. Henke, Jr. <br />Date of Death: October 7,2006 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Marlene E. Henke <br />Date of Marriage: October 30, 1966 <br />2. The Affiant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due <br />because of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse <br />of the Decedent in joint tenancy, to-wit: <br />Lot Four (4) in Block Twenty-five (25) in Russel Wheeler's Addition to the City of <br />Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair market value of $63,395.00. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance <br />Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien <br />by reason of Nebraska Revised Statutes Section 77-2102. <br />FURTHER AFFIANT SAITH NOT. <br /> <br />~m(1 ~~ t; ~------ <br />Marlehe E. enke- <br /> <br />SUBSCRIBED and SWORN to before me this!L day of tip/kJ, 2007. <br />:: , ' I <br />N~t1~{ ~~~~I- ~/a xJfJI <1--/ <br /> <br /> <br />GENERAL NOTARY - Slate of Nebraska <br />SHERRY SASGES <br />M Comm. . June 4 2008 <br />