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~,r r <br />2010059'3 <br />AFFIDAVIT OF MARITAL STATUS <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />information is true and correct. <br />1. Name of Decedent: Gregory S. O'Rourke <br />Date of Death: November 16, 2004 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Audrey M. O'Rourke <br />Date of Marriage: October 23, 1943 <br />2. The Affiant is the surviving spouse of the Decedent and in that capacity is familiar <br />with the marital status and the death of the Decedent. <br />3. That there is na federal estate tax, Nebraska inheritance tax or Nebraska estate tax <br />due. <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />Lot Thirty-Eight (3$), in Hagge's Subdivision, City of Grand Island, Hall <br />County, Nebraska. <br />5. As of the date of death, the real estate had a fair market value of $96,331.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. There <br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. <br />There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2.1.02. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />STATE OF NEBRASKA ) <br />ss: <br />COUNTY OF HALL ) <br />~~ j <br />Audrey MAO' ourke, Affia t <br />SUBSCRIBED and sworn to before me on this~`Jday of C , 2010 <br />by Audrey M. O'Rourke, Affiant. <br />ee~n wr-sa~aNen~ <br />,1AMiE MIJE$ JANKQNiTZ <br />Gamy. ~, Z014 <br />,~ n.~ <br />N ary Public <br />_ PREPARED BY: <br />~~ Jamie Mues Jankovit~ # 20754 <br />BRADLEY, ELSBERND, ANDERSEN, <br />KNEALE & MUES JANKOVITZ, P.C. <br />202 West Third Street <br />P.O. Box 639 <br />Grand Island, NE 68802 <br />Telephone: (308) 382-2128 <br />