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�- �� �• - � -� �. ..�� � � � � N = �� - �� - �� tC��' � � �-�:. �� i t� �. � � � a� � " � � � � � � � S� � � � � STATE OF NEBRASKA C4UNTY 4F HALL � a� � � � � � � � �- �� � _ ��, ;,�� 0 �� _. �' r .. n G� : „ in r -� r� c , �-�'� o ` '�� m `� m � AFFIDAVIT OF MARITAL STAi't.1�5 j ss. ) :~v r � s --+� r�. � h--+ � � � CD ►-� � C? (n � � c n a --a � m � o o � � � = r� � � � � r D � � v �� � �n . 0 N 0 F--+ � � � F-� F"� N COIVIES IVOW, the undersigned, being first duly sworn upon oath, and deposes and states that the undersigned knows the Decedent and the surviving spouse of the Decedent and that the follow�ng information is true and correct. 1. Name of Decedent: Floyde R. Loy Date of Death: August 6, 2011 Domicile at Death: Cairo, Ha{I Gounty, Nebraska Name of Surviving Spouse: Barbara A. Loy Date of Marriage: November 23, 1968 2. The Affiant is the daughter of the Decedent and, in that capacity, is familiar with the maritaf status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to-wit: Lots Two (2) and Three (3), Block Four (4), First Addition to Cairo, Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $63,185.00. 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute §77- 2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77- 2� 02. FURTHER Affiant saith not. orie Earnest Subscribed and sworn to before me this � day of August 2011. �_�� otary Public �a� r� � �t� -- � il� ��