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AD n z rd n i A c A r, -r m W, ~ co CD 6 x n~ z rn -0 n m C) ~ N r*t ~r > , 4A6 _ p co r~ Q AFFIDAVIT OF MARITAL STATUS 201002044 d 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: Diann Marie Elstermeier Date of Death: September 22, 2009 Domicile at Death: 1304 Mansfield Road Name of Surviving Spouse: Norman Elstermeier Date of Marriage: August 6, 1966 2. The Affiant is the husband 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 or 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 Twenty-three (23), Grand West Subdivision in the City of Grand Island, Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $164,625.00. 6. The Decedent and the surviving spouse were married as of the date of death. There is no 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. Norman Elstermeier, Affiant STATE OF NEBRASKA ) ss: COUNTY OF HALL ) SUBSCRIBED and sworn to before me on this day of 2010, by Norman Elstermeier, Affiant. GENERAL NOTARY - State of Nebraska JAMIE MUSS JANK~VrTZ Notary Public ~My Comm. Ex~ PMaY 25, 201D PREPARED BY: 4'F T 7"o p Jamie Mues Jankovitz # 20754 BRADLEY, ELSBERND, ANDERSEN, KNEALE & MUES JANKOVITZ, P.C. 202 West Third Street P.O. Box 639 Grand Island, NE 68802 Telephone: (308) 382-2128