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<br /> <br />~ <br />~ <br />0,:, <br />\:) <br />~ <br /> <br /> ;0 n () <br /> m ::t: )> <br /> -n <br /> C r'f1 (11 <br /> 2" n :r: <br />(l ;n;; (rl <br />J:: ri ()i r~ <br />> ~) C;;.;:;J 0(.1) a <br />,,, ~ <br />() ;:.", ~ '-., -...J 0--1 C'.)(ti <br />"" :c .--:t:t, C/) c;;: > ~ <br /> ;0 /Ci\. """'1 2t ~ <br /> ~ m $'1- """0 --i f'T1 <br /> v"7) '....... -< 0 ~~ <br /> <0 "''\~ ....... 0 -." <br /> " c.::> " z - <br /> tV r ::t:: rr'1 -.J~ <br /> m -0 >- W <br /> m og <br /> l\:iI ::3 f ;J.r.:1 <br /> W r- l> -.J <br /> ~ (.I) ~i <br /> N ;:p:; <br /> ~ <br /> 0 -.~ <br /> -C clt.. ~ <br /> .CA en <br /> ,. <br /> <br />t~r <br />,,~ ~-- <br />~ ~ ~...-." <br />~~ ~ <br />~.~ ~.:' <br />~ <br /> <br />N <br />S <br />S <br />-..J <br />S <br />-..J <br />-..J <br />-..J <br />CJ) <br /> <br />AFFIDAVIT OF MARITAL STATUS <br /> <br />STATE OF NEBRASKA <br /> <br />) <br />) ss <br />) <br /> <br />JO,51J <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: Mark A. McCarville <br />Date of Death: July 28, 2007 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Diane C. McCarville <br />Date of Marriage: August 15, 1981 <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 because <br />of Decedent's death. <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to-wit: <br />Lot Fifteen (15), Westroads Estates Fourth Subdivision, Hall County, Nebraska. <br /> <br />5. As of the date of death, the real estate has a fair market value of $113,386.00. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77~2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77-2102. <br /> <br />FURTHER AFFIANT SAITH NOT. <br /> <br />,,[)~~ (L '--{'Y\tt (l.~J2J t_Q_!J; <br />Diane C. McCarville <br /> <br />SUBSCRIBED and SWORN to befme ~e:te=~_ <br /> <br /> <br /> <br />66<_ NOTARY. Stat. oj Neb",.. otary Publ ic 'P <br />GALEN E. STEHUK t <br />MyComm. Exp, May1, 201& <br /> <br />