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�� <br />�� <br />�� <br />__ <br />�� <br />N � <br />A = <br />� �� <br />0 <br />Cn �� <br />� �� <br />� �� <br />�� <br />�� <br />�� <br />�� <br />� <br />� <br />� � <br />� � � <br />Ta � <br />�^.- � <br />� � � � <br />�.J � o -� � <br />� �� � <br />� � ,- t— z —� N <br />1'�1 r i� �^ r-- �°' - �{ m C3 � <br />� � c-� � ',._ -G p � <br />aC o ; o - �.'' <br />� OD 'T� z ha <br />c� �p �� O <br />� r� � <br />r� � r v � <br />�-' v' o � <br />o (, T� c.J 7� <br />[ = • 1 ' Q� <br />Q �° _C �i .,`i � <br />rn � N cn S <br />o � �, <br /><n <br />AFFIDAVIT OF MARITAL STATUS <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that she <br />is the surviving spouse of the Decedent and that the following information is true and correct. <br />l. Name of Decedent: Orval Hjorth <br />Date of Death: May 17, 2011 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Mavis June Hjorth <br />Date of Marriage: July 7, 1954 <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. <br />due. <br />� <br />That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax <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 Six (6), Block Three (3), Doniphan Village Original Town, Doniphan, <br />Nebraska <br />5. As of the date of death, the real estate had a fair market value of $57,865.00 total. <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. There is no <br />Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />��; ,`• , <br />� �. <br />e � �{ �� � `���� �°—�--Zr�-- <br />Mavis June H�4rth, Affi <br />STATE OF NEBRASKA <br />COL11�1TX OF HALL <br />) <br />) ss: <br />) <br />SUBSCRIBED and sworn to before me on this � day of �"�� � , 2011 <br />by Mavis June Hjorth, Affiant. <br />GENERAL NOTARY-State of Nebra�ka ' l�-� -�� <br />JAIV�IE MUES JANiCOVITZ N ary Public <br />��� �,� --- My Comm, E�cp. May 25, 2014 <br />PREPARED BY: <br />Jamie Mues Jankovitz, #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 b8802 <br />Telephone: (308) 382-2128 <br />�� � <br />