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nM mn _ m M~ ® ITI Z~+ rya m . by S = o' rn v g to ~ -c c' can t7 v~1 Q0 M CD cr) _ to co ~ C" rn ~ Q a AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ) ) ss• COUNTY Of HALL ) COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the surviving spouse of the Decedent and that the following information is true and correct: 1. Name of Decedent: Richard George Decker Date of Death: February 8, 2009 Domicile at Date of Death: Hall County, Nebraska Name of Surviving Spouse: Jayne A. Decker Date of Marriage: June 25, 1977 2. The Affiant is related to the Decedent as follows: surviving spouse. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because of Decedent's death. 4. Title to the following described real estate is held by the Decedent and the surviving spouse of the Decedent in joint tenancy, to-wit: Lot Five (5) in Block "B" in Parkview Subdivision located in the Northeast Quarter (NE1/4) of Section TwentyNine (29) and the Northwest Quarter of Section Twenty Eight (28) in Township Eleven (11) North, Range Nine (9) West of the 6th P.M. in Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $116,831.00. 6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statutes Section 77-2102. FURTHER AFFIANT SAITH NOT. I ne A. Decker SUBSCRIBED and SWORN to before me this 5-day of March, 2009. GENERAL NOTARY - State of Nebraska GALEN E. STEHLIK My Comm. Exp. May 1, 2010 otary Public