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<br />I'\.) <br />is <br />is <br />--.J <br />is <br />W <br />is <br />m <br />(J1 <br /> <br />c;;"173:= <br />""S 0 P <br />P ~t~ <br />a ~ ~-l <br />l-j - 1- <br />r.-. U\ <- <br />P EO- -- <br />6.VJc1 <br />J- <br />::5 <br /> <br />;JO <br />m <br />"" <br />c: <br />~~~ <br />nCfJ <br />~:c <br /> <br />""........,...:1. <br />,..........-11 ~ <br />~ ;.>. "', <br />p, ~" <br />,,~) ~, .... ~"- <br />c> '<~~: <br />""1"1 <br /> <br />~ ~;:.:~~ <br /> <br />C~ <br />(I) :.. <br /> <br />t- <br /> <br />nn <br />%)10- <br />m en <br />n:c <br />'" <br /> <br />- <br /> <br />o <br />o <br /> <br />z:.. <br />rn <br /> <br />6"- <br />""'Co <br />'"6 <br />o <br />IV <br /> <br />AFFIDAVIT OF MARITAL STATUS <br /> <br />STATE OF NEBRASKA <br /> <br />ss: <br /> <br />COUNTY OF HALL <br /> <br />~~ <br />~ <br /> <br />o Ul <br />o -1 <br />c: ;t>> <br />Z-1 <br />-jfT1 <br />-< c::) <br />o ., <br />.....,., ......... <br />::r: n 1 <br />p CD <br />r ;:0 <br />,p <br />U) <br />;;-;; <br />P <br />-- <br /> <br />::!) <br />-0 <br />=0 <br />........ <br />-..J <br /> <br />::n <br />::3 <br />........ <br />C) <br />G) <br />I-" <br /> <br />en <br />UJ <br /> <br />COMES NOW the undersigned, being duly sworn, and deposes and <br /> <br />says that the undersigned knew the Decedent and knew the <br /> <br />surviving spouse of the Decedent and that the following <br /> <br />information is true and correct: <br /> <br />1. Name of Decedent: Mary Magdalena Garcia, also <br />known as Mary G. Garcia <br /> <br />Date of Death: August 12, 2000 <br /> <br />Domicile at Date of Death: Hall County, Nebraska <br /> <br />Name of Surviving Spouse: Leandro Garcia (now also <br />deceased as of March 15, 2007) <br /> <br />Date of Marriage: April 30, 1962 <br /> <br />2. The Affiant is related to the Decedent as follows: <br /> <br />Daughter. <br /> <br />3. There is no federal estate tax, Nebraska inheritance tax <br /> <br />or Nebraska estate tax due. <br /> <br />4. Title to the real estate, as set forth below, was held <br /> <br />by the Decedent and the surviving spouse 0: the Decedent in joint <br /> <br />tenancy: <br /> <br />The West 8 Feet of Lot 5 and the East 49 Feet of Lot 4, <br />except the North 30 Feet to the City, all in Block 2, <br />Westerhoff's First Subdivision, City of Grand Island, <br />Hall County, Nebraska. <br /> <br />5. As of the date of death, the real estate had a fair <br />market value of: $80,000.00. <br /> <br />~ <br />~I <br />~~ <br />~i <br />~i <br />U1~ <br /> <br />//.ffD <br />