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<br /> ~, AFFIDAVIT OF MARITAL STATUS
<br /> ~
<br /> ~
<br /> STATE OF NEBRASKA )
<br /> ) ss.
<br /> COUNTY OF HALL )
<br />
<br />
<br />
<br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states
<br />that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the
<br />following information is true and correct.
<br />
<br />1. Name of Decedent: Larry E. Bellamy
<br />Date of Death: December 26, 2008
<br />Domicile at Death: Cairo, Hall County, Nebraska
<br />Name of Surviving Spouse: Alice M. Bellamy
<br />Date of Marriage: September 2, 1961
<br />
<br />2. The Affiant is the son of the Decedent and, in that capacity, is familiar with the marital
<br />status and the death of the Decedent.
<br />
<br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due.
<br />
<br />4. Title to the following described real estate is held by the Decedent and the surviving
<br />spouse in joint tenancy, to-wit:
<br />
<br />The Northwest Quarter (NW1I4) of Section Thirty (30), Township Twelve (12) North,
<br />Range Eleven (11), West of the 6th P.M., Hall County, Nebraska, except the
<br />following described property: The Easterly Three Hundred and Thirty-Seven Feet
<br />(337') of the Northerly One Thousand Four Hundred Twenty Feet (1,420') of the
<br />said Northwest Quarter of Section Thirty, said exception containing 10.986 acres
<br />more or less.
<br />
<br />-'-
<br />--
<br />\t'
<br /><::)
<br />
<br />The Northeast Quarter (NE1/4) of Section Twenty-Three (23), Township Twelve
<br />(12) North, Range Twelve (12), West of the 6th P.M., Hall County, Nebraska,
<br />excepting a tract deeded to the State of Nebraska, more particularly described on
<br />the Warranty Deed recorded in Book 77, at Page 698, of the Deed records of Hall
<br />County, Nebraska, and also excepting therefrom a tract of land deeded to the State
<br />of Nebraska, Department of Roads, more particularly described in Warranty Deed
<br />recorded as Document #95-102715 in the records of the Hall County Register of
<br />Deeds, and also excepting a tract deeded to John P. Bellamy and Bonnie S.
<br />Bellamy, more particularly described on the Quitclaim Deed recorded on January
<br />6, 2003, as Document #200300072 in the records of the Hall County Register of
<br />Deeds.
<br />
<br />The East Half of the Southeast Quarter (E1/2SE1/4) of Section Thirty-Six (36),
<br />Township Twelve (12) North, Range Twelve (12), West ofthe 6th P.M., Hall County,
<br />Nebraska.
<br />
<br />5. As of the date of death, the real estate parcels had an assessed value of $266,013.00,
<br />$142,500.00, and $270,124.00, respectively.
<br />
<br />6. The Decedent and the surviving spouse were married as of the date of death. There
<br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute fj77 -2003. There is no
<br />Nebraska estate tax lien by reason of Nebraska Revised Statute fj77-21 02.
<br />
<br />FURTHER Affiant saith not.
<br />
<br />~~.A
<br />Matthew A. Bellamy d
<br />
<br />GENERAl NOTARY - Slate of Nebraska
<br />DENISE D. MYE:RS
<br />My Comm. Exp. Nov, 20. 2010
<br />
<br />
<br />Subscribed and sworn to before me this S day of
<br />"
<br />
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