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<br />N <br />S <br />51 <br />C):l <br />CSl <br />C):l <br />(j) <br />-...J <br /><0 <br /> <br /> <br />'--------,,_ _'M__j <br /> <br />~~ <br />~~~ ~ <br />\':l ......... <br />~ ~~ -l-:, <br />,,~ ... '" <br />LJ ~ <br />i...\~' ~.... <br />Q-- ~ '" c-.., <br />;) ~'.~' <br />" ~~ <br />'" <br />~ '" .,'";S' . <br />'rJ\.~~. <br />t-- .~ <br />~ i' <br />f'l ~ <br /> <br />'- <br /> <br />~ <br />"""- <br />.~ <br /> <br />n~ <br />~CIl <br />n% <br />:::-;: <br /> <br /> I"....,,;) d m <br /> ,C.;:Jo 0 (fJ ~ <br /> c::,.-, 0 --i <br /> c>::> <br /> :-);( c l> N m <br /> c,~ :z: --i :D <br />:u ~." '::''':> -i rn C) gJ <br />6 ~): ~ -< C' <br />o"~ I--' 0 ;, 0 . :J> <br />J: ,\ ~~ co en <br />.,.., tS; rn z <br /> x C> <br />0 :t>- CD ~ <br />rr, r' -U <br />P'1 :i :3 r- ::v co <br /> r 1> :0 <br />0 (n C <br />(Jl OJ <br /> 0 I--' A g <br /> 1> ~ m <br /> I--' --- Z <br /> N (fl CD -I <br /> w Z <br /> 0 <br /> <br />jig <br />m <br />"" <br />c: <br />n Z <br />~~~ <br />ncn <br />",,% <br /> <br />I <br /> <br />~ <br />~ <br />:Il' <br /> <br />AFFIDAVIT OF MARITAL STATUS <br /> <br />200808679 <br /> <br />STATE OF NEBRASKA <br /> <br />) <br />) ss. <br />) <br /> <br />If) ,j'/) <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: Darrel G. Rewerts <br />Date of Death: May 7, 2008 <br />Domicile at Date of Death; Hall County, Nebraska <br />Name of Surviving Spouse: Patricia J. Rewerts <br />Date of Marriage: July 2, 1960 <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 Decedentand the surviving spouse ofthe <br />Decedent in joint tenancy, to-wit: <br />Lot Seventy-eight (78) in Buenavista Subdivision, an addition to the City of <br />Grand Island, Hall County, Nebraska. . <br /> <br />5. As of the date of death, the real estate has a fair market value of$58,133.00. <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 />~'U~ ~~ <br />Patricia J. Rewerts <br />SUBSCRIBED and SWORN to before me this ~ day of October, 2008. <br />~&:1 ~ <br /> <br />'~';" :~~: ,. <br /> <br />GfHERAl. NOTARY. State of Nebrasa <br />SHERRY SASGES <br />CGml. &p...... 4, 2011 <br />