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G"I~0 :10 n ~ m ~ % ......:> ~ ~ ~3 m c:;:a C> (.I) ~ c;:::> ~ n :c ~ 0-1 s:.....k M n Z ~ ::*- c:l>- r<o;:t :0 :c E c :D z-t m H~' ~ ~r -0 -tfTI 0 C N V\~(A. PI r'f1 .... :::0 -<0 IS J:)(::,-+- ..-- '- 0 6; IS ::5 (\ ~ :c <. ..- 0"" <D SL. ;:r 0 W ""T'lZ CD Z IS ~ ~ - tt ::J: fTl N ~ r::'- 0 :r>co 0 ~ ""-J r.\ rn l -0 r- ;0 IS rr1 ::3 I"'\,) (JJ 6"- Cl r :r> C ..., (j) (fl -.J 3: ~ ,....... 7" m ~ l>- 0 ~ ,....... ..........'~ -.J (J') (.J'1 Z .Il. (/) 0 '----- AFFIDAVIT OF MARITAL STATUS /o.to STATE OF NEBRASKA. ) ) ss. ) COUNTY OF HALL COMES NOW, the undersigned, being duly sworn, deposes and states that the undersigned is the surviving spouse of the Decedent, and that the following information is true and correct: 1. Name of Decedent: Raymond Del Hagenmaster Date of Death: January 6, 2009 Domicile at Date of Death: Hall County, Nebraska Date of Marriage: March 1, 1949 2. The Affiant is the surviving spouse of the decedent. 3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that arose, or can arise, by virtue of the Decedent's death. 4. Title to the following described real estate was held by the Decedent and Lavina Hagenmaster, the Decedent's spouse, on the date of the Decedent's death, to-wit: Lot Twenty-four (24) in Block One (1) in Continental Gardens, an addition to the City of Grand Island, Hall County, Nebraska. 5. As of the date of death, the real estate has a fair market value of $114,048.00. 6. The Decedent and Lavina Hagenmaster were married as of the date of death of Raymond Del Hagenmaster. There is no Nebraska Inheritance Tax lien, and no Nebraska inheritance tax lien. AND FURTHER AFFIANT SAITH NOT. d c:tL ~_~ Lavina Hagenmaste Subscribed and sworn to before me this ~ day of April, 2009. GENERAL NOTARY. State 01 Nebraska GALEN E. STEHLIK My Comm. Exp. May 1, 2010 ~