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- <br />�� <br />- <br />�� <br />N � <br />B = <br />e <br />� � <br />N - <br />�� <br />� <br />� <br />3 <br />-�c <br />� '^ <br />v 1 <br />$ <br />� <br />+� <br />� <br />M <br />� <br />� <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />� <br />n <br />�e <br />A � <br />PWI ;A <br />� � <br />n . �t <br />_ � � `� <br />._._. <br />� g «_.... <br />D �. <br />r c <br />i r � t "_ <br />c- r <br />G �a � <br />� �V <br />m � _. <br />C) I__., <br />, cn �.. � <br />� � � <br />rn <br />,� <br />� O -� �� 0 <br />o �< <br />� � <br />C � "' (� <br />� <br />AFFIDAVIT OF MARITAL STATUS <br />} ss. <br />) <br />ca cn <br />O —{ <br />C � <br />� --4 <br />� m <br />� O <br />O �1 <br />^'' z <br />= rn <br />D O� <br />r � <br />r n. <br />� <br />� <br />D <br />C./) <br />cn <br />COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and <br />states that the undersigned knows the Decedent and the surviving spouse of the Decedent <br />and that the following information is true and correct. <br />Name of Decedent: Merle Simmons <br />Date of Death: September 19, 2010 <br />Domicile at Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Janice M. Simmons <br />Date of Marriage: January 7, 1977 <br />2. The Affiant is the step-daughter 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 no federal estate tax, Nebraska inheritance tax or Nebraska estate <br />tax due. <br />4. Title to the following described real e�tate is held by the Decedent and the <br />surviving spouse in joint tenancy, to-wit: <br />Lot Twelve (12), Block One (1), Gosda Subdivision, City of Grand Island, <br />Hall County, Nebraska. <br />5. As of the date of death, the real estate had a fair market va�ue of $91,351.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. <br />There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- <br />2003. There is no Nebraska estate tax lien by reason of IVebraska Revised Statute §77- <br />2102. <br />FURTHER Affiant saith not. <br />Suz ne �ehrle <br />O <br />N � <br />O <br />�"� � <br />F-� � <br />O � <br />Crl � <br />C.eJ � <br />� �. <br />N � <br />g� <br />i p, <br />Subscribed and sworn to befor� me this � day of _____�, 2011. <br />� <br />�� �n��, <br />` Notary Public ,.,,, <br />�lt �•�t�rs <br />�m <br />