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<br />1'0 <br />($I <br />($I <br />--...J <br />($I <br />0:> <br /><..n <br />+::- <br />0:> <br /> <br />GJ <br />,-, ~)l>. <br />VJ"'- _ <br />~ '" <br />::S ~;:s <br />CL.. ~ V) <br />I-I..c. i1 <br />~~ ~ <br />p <::::. -- <br />~ 7\ <br />A... <br />2: <br />li"\. <br />~ <br />I:>c <br />~ <br />f\l <br /> <br />10 <br />m <br />." <br />C <br />Z <br />('\(")C1 <br />~)>c.n <br />()~ <br />;"1;...... <br /> <br />on <br />:r:1:> <br />1"1' ;:.r <br />o ~:r <br />:;:'1\ <br />\~ <br />lJ) <br />CJ <br /> <br /> 1-":> ;i) <br /> c.;> ('") 11I'1. 0 <br /> 0;:;0 <br /> ~ 0 --I ::s <br /> ""'" .J c P. N r'f' <br /> ,..,.1",-. c:::> Z --l (1) <br />;>J ~~' .::;-:> -~ fT1 0 [ <br />rn 'i,. --f -< <br />o - 0 0 <br />o~ 0 -" l;' <br />....c -"..-) ."..". --.J <br />-.,., ~- <br /> r ::.c rr1 - <br />0 1> r..::, <=> ~ <br />rn ::D r :::0 <br />rn :::3 co <br />C) r :r..-,. <br /><I' ~ (J). CJ1 <br /> 0 :;><; i <br /> 1> ....c <br /> ....r:: .................. <br /> co (J'J CD <br /> en Z <br /> 0' <br /> S 50 <br /> <br />200708548 <br /> <br />AFFIDAVIT OF MARITAL STATUS <br /> <br />STATE OF NEBRASKA ) <br />) ss. <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: Donald Lee Wirtz <br /> <br />Date of Death: May 15, 2007 <br /> <br />Domicile at Date of Death: Hall County, Nebraska <br /> <br />Name of Surviving Spouse: Cora Marian Wirtz <br /> <br />Date of Marriage: September 7, 1957 <br /> <br />2. The Affiant is related to the Decedent as follows: survlvmg spoilse. <br /> <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because <br /> <br />of Decedent's death. <br /> <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br /> <br />Decedent in joint tenancy, tOM wit: <br /> <br />Lot Five (5), Block Five (5) in Valley View Subdivision in the North 1103.0' <br />E 1/21'J21/4 Se..:.ti0!1 Two;:~ty-tw') (22), Township Fleven (11 J North. Range <br />Nine (9), West ofthe 6th P.M., Hall County, Nebraska. <br /> <br />5. As of the date of death, the real estate has a fair market value of $74,406.00. <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br /> <br />lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by r~aSO!1 <br />of Nebraska Revised Statutes Section 77-2102. <br /> <br /> <br />FURTHER AFFIANT SAITH NOT. <br /> <br /> <br />~ <br /> <br />Cora Marian Wirtz <br /> <br />~ <br /> <br />SUBSCRIBED and SWORN to before me this~day of September, 2007. <br /> <br />-~ <br /> <br />J<6tary Public <br /> <br />GENERAl NOTARY. State of Nebraska <br />GALEN E. STEHLIK <br />My Comm. Exp. May 1,2010 <br />