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~~ ~~ ~~ j~ O ~ ~ ~ ~ ~ ~ ' ~-~ m ~ C.TI ~w ~ (~~ ~.~... ~ ~~ ~ ~ o n ^-a m, r:_9 C7 U? ~, - ~ x ~ ~ ~, ~ rn to ~. , ~ ~ m n = ~, ~ ~ ~" ~ n n a ~ ~„ ~ ~ ~ ~© N ~ ~~ ~~ ~ ~ -~ -~ ~ ~,~ `~ ~ ~ ~, _ . ~_ ~,, z m "C7 ~ ~ t"'_ IY Cfl ~' ~ cn ~pC ~ ~ m ca © cry ~' Z' ; CT 20o9o5~soo AFFIDAVIT OF MARITAL STATUS Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Harry Albina Eariatti Date of Death: May 8, 2009 Domicile at Death: Grand Island, Nebraska Name of Surviving Spouse: Nancy C. Eoriatti Date of Marriage: January 18, 1949 2. The Affiant is the wife of the Decedent and in that capacity is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax ar Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to wit: Lot Eighteen (18), in Black One (1), in Knickrehm Second Addition to the City of Grand Island, Nebraska. . 5. As of the date of death, the real estate had a fair market value of $99,998.00. 6. The Decedent and the surviving spouse were married as of the date of death. There is na Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. FURTHER THIS AFFIANT SAYETH NOT. STATE OF NEBRASKA ) ss: COUNTY OF HALL ) ~~ ~~raa ~ • ~~ Nancy C. iatti, Affiant SUBSCRIBED and sworn to before me on this 15th day of July, 2009 by Nancy C. Eariatti, Affiant. GENERAL. NOl'ARY -State o1 Nebraska JAMIE MUES JANtC~V17Z - My Comm. lxp. May 25, 2010 ~~ ,A. Erten, #11184 BRADLEY, ELSBERND, EMERTON, ANDERSEN & KNEALE, P.C. 202 West Third Street P.O. Box 639 Grand Island, NE 68802 Telephone: (308) 382-2128 N ary Public PREPARED BY: ~.