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� <br />� <br />� <br />N � <br />0 � <br />� <br />� � <br />� � <br />B <br />N <br />� � <br />0 � <br />� <br />- <br />� <br />� � � � <br />s`',�; '--' o -� p <br />D _ � C A <br />� r , � Z --a E1J � <br />�, � . --1 + 37 <br />a a. � -� o ° �T+ <br />r*� W o � F"'' � <br />:v �,.,. _ <br />c' (_ = m t--+ :d! <br />r-._... � <br />�' "� 2 � m O <br />r, � � r � � <br />�ri r-- � N <br />O ,�.. ,, } � � � <br />o �' , . � � <br />f' �� `f�ti.i �L <br />V7 � _� � � <� <br />� <br />f�1 (.�� <br />�� <br />d <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 <br />2 <br />3 <br />� <br />5 <br />6 <br />Name of Decedent: Donald T. Brooks, Jr. <br />Date of Death: January 14, 2011 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Carolyn J. Brooks <br />Date of Marriage: September 30, 1977 <br />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 />That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax <br />due. <br />Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />LOT ONE (1),1N BLOCK FIVE (5), IN KAY-DEE SUBDIVISION 1N THE CITY <br />OF GRAND ISLAND, HALL COUNTY, NEBRASKA <br />As of the date of death, the real estate had a fair market value of $ 137,500.00. <br />The Decedent and the surviving spouse were married as of the date of death. There <br />is no Nebraska inheritance tax lien by reason ofNebraska Revised Statute § 77-2003. <br />There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- <br />2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />� � <br />Carolyn J Br oks, Affiant <br />- -- -- - ----- <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />� <br />f'1'1 <br />'17 <br />e <br />a n N <br />�_.. <br />) <br />) ss: <br />) <br />SUBSCRIBED and sworn to before me on this �`�� day of L�� , 2011 <br />by Carolyn J. Brooks, Affiant. y <br />�� <br />/C <br />GENERAL NOTARY - State of Nebraska ` - - � <br />JAMIE MUES JANKOVI7Z � � � <br />�� �� +� __��. My Comm. Exp. May 25, 2014 N tary Public � <br />PREPARED BY: <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY,ELSBERND, ANDERSEN, KNEALE <br />& 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 />