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~^ <br />~r <br />~. <br />~~ <br />~~ <br />~~ <br />~~ <br />~ ..~~ <br />r~~ <br />t~~ <br />~~ <br />~~ <br />~~ <br />4 <br />~° a <br />~va~ y. <br />a~,.~, <br />h ~ '~~•~ <br />~~ a~ <br />~ r~ <br />d <br />M <br />6\. ~ <br />b 'y <br />N o <br /> <br /> ,~ n ~ ~ o <br /> = <br /> X1'1 1' <br />1"1 N ,~~,~" "~ ~ ~ <br /> <br /> <br />rn ~ w ~ ru <br /> <br /> -o <br /> ,~ ~ ~- <br />`~ <br /> o ~ <br /> O <br /> n <br /> <br /> ~: ~ <br /> crx <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />)ss. <br />COUNTY OF HALL ) <br />c~ <br />N <br />p <br />ca <br />~. <br />cry. <br />~- <br />COMES NOW, the undersigned, being duly sworn, deposes and states that the <br />undersigned is the surviving spouse of the Decedent, and that the following information is true <br />and correct: <br />1. Name of Decedent: Karen Dianne Kleine. <br />Date of Death: February 24, 2010 <br />Domicile at Date of Death: Hall County, Nebraska <br />Date of Marriage: June 7, 1964 <br />2. The Affiant is the surviving spouse of the decedent. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax ar Nebraska Estate Tax <br />that arase, or can arise, by virtue of the Decedent's death. <br />4. Title to the fallowing described real estate was held in joint tenancy by the <br />Decedent and Larry G. Kleine, the Decedent's spouse, on the date of the <br />Decedent's death, to-wit: <br />East Two (2") Feet of Lot Nine (9) and West Fifty Seven Feet (57') of Lot <br />Ten (10) Block Three (3), Cunningham Subdivision, City of Grand Island, <br />Hall County, Nebraska. <br />Together with all buildings, fixtures, improvements and appurtenances belonging <br />to such premises. <br />5. As of the date of death, the real estate has a fair market value of $78,065.00. <br />6. The Decedent and Larry G. Kleine were married as of the date of death of <br />Karen Dianne Kleine. There is no Nebraska Inheritance Tax lien, and no <br />Nebraska Inheritance Tax Lien. <br />AND FURTHER AFFIANT SAITH NOT. <br />_ ~ ~~~-+1-~. <br />Lany~G. l~eine <br />Subscribed and sworn to before me this ~ ~ ~ day of April, 2010. <br />GENERAL NOTARY -State of Nebraska <br />~ JULtE J. SI:E~N <br />~~. My Camm, Exp, Juty 19, 2l)11 <br />~ ~ ~~-, <br />Notary Public <br />m <br />v <br />2 <br />O <br />~~~~ <br />estate.kleine <br />Affidavit of Marital Status <br />