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� <br />� <br />� <br />N � <br />0 <br />� � <br />� � <br />B <br />� � <br />� - <br />N <br />� <br />� <br />� <br />�� <br />� 4 � <br />� °� �~ <br />� � � <br />� � � <br />� ��. <br />..�a� � <br />i� '�- <br />�. <br />� <br />� <br />� <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />� <br />1'!f <br />C <br />{'y � <br />, :-.n� <br />, ;�N <br />� <br />! <br />� <br />� � <br />A � <br />� <br />�i <br />2oiioiss� <br />AFFIDAVIT OF MARITAL STATUS <br />) <br />) ss. <br />) <br />��. <br />w� � �: <br />x l-� �--• o --� � <br />C '> <br />� , � Z --� N <br />s-- r .° . � -1 m d <br />� ,, .; , . -� o � <br />G' r p "Tl 1-� <br />� �" � � � '''- F-, � <br />n }:_:_� s rr� <br />v , -. b w o <br />r � � � <br />r n �—' <br />o - � � � Gl� <br />-n �, <br />O `u�...-. � �� � . <br />m � � cn N � <br />a � � <br />cn <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the � sv <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Jackie L. Pielstick, also known as Jackie Pielstick, or <br />Jacqueline Laroyce Pielstick <br />Date of Death: Apri18, 2007 <br />Domicile at Date of Death: Hall County, Nebraska <br />Name of Surviving Spouse: Terry L. Pielstick <br />Date of Marriage: October 28, 1977 <br />2. The Affiant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance Tax or Nebraska Estate Tax that is due because <br />of Decedent's death, <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to-wit: <br />The South Half of Lot Eight (8), Block Nine (9), Voitle's Addition to the City <br />of Grand Island, Hall County, Nebraska. <br />5. As of the date of death, the real estate has a fair market value of $48,796.00 <br />6. .The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77-2102. <br />FURTHER AFFIANT SAITH NOT. <br />Terry L. elstick <br />SUBSCRIBED and SWORN to before me this �d y of M ch, 2011. <br />� GfNERpi.Rpi�. NOTARY - ofte N�xaska ary Publi <br />GAIEN E STEHtIK <br />�, My Comm. Exp. May 1, 2014 <br />