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_�;,._ <br />�.�r...,9b;�. <br />..j., <br />- <br />- <br />� <br />- <br />�� <br />0 - <br />� �� <br />� <br />� <br />C11 ,� <br />0 � <br />� - <br />..� <br />�� <br />.� <br />- <br />� <br />� <br />� � <br />� <br />� � <br />� <br />\ <br />�� <br />D `. <br />r r <br />r r°, � <br />r ., r ,, ; -... <br />G �� - <br />� <br />m �_-- <br />c� � -, <br />G�? � <br />� <br />r� <br />_� <br />o �-� <br />�, , <br />Q ti. =� <br />i� � <br />m <br />� �� <br />�� <br />�� <br />� <br />c- <br />G7 <br />�� <br />F-' <br />_.� <br />� <br />N <br />N <br />N <br />C� <br />C� G� <br />O -{ <br />C D <br />� m <br />---i <br />� O <br />O �i <br />� ` <br />T P <br />�S• Q7 <br />r � <br />r n <br />U'� <br />� <br />D <br />� <br />Cf9 <br />O <br />N <br />O <br />6'-'J <br />h--a <br />� <br />� <br />Ul <br />O <br />F-� <br />AFFIDAVIT OF MARITAL STATUS <br />COMES NOW, the undersigned, being first duly sworn upon oath, deposes and sta.tes that <br />the undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />informarion is true and correct. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Name of Decedent: Marsha Medbery <br />Date of Death: August 5, 2011 <br />Domicile at Death: Ha11 County, Nebraska <br />Name of Surviving Spouse: George Medbery <br />Date of Marriage: November 18, 1979 <br />The Affiant is the spouse of the Decedent and in that capacity is familiar with the <br />marital status and the death of the Decedent. <br />That there is no federal esta.te 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 />The Westerly Twenty Six (26) Feet of Lot Three (3) and the Easterly Forty-Siac (46) <br />Feet of Lot Four (4), a11 in Block Forty-Four (44), in Charles Wasmer's Second <br />Addition to the City of Grand Island, Ha11 County, Nebraska <br />As of the date of death, the real estate had a fair market value of $113,384.00. <br />The Dec�ent and the surviving spouse were married as of the date of dea.th. There <br />is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. <br />There is no Nebra.ska estate tax lien by reason of Nebraska Revised Statute §77-21 O2. <br />FURTHER TffiS AFFIANT SAYETH NOT. <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />ss: <br />� , �/ <br />_i1li: �,�� � � �JI /.-= "� <br />� <br />_� �. ,.��_ .� � <br />� <br />✓� <br />SUBSCRIBED and sworn to before me on this o���`' da.y of ��� ,�9�t . 2011 <br />by George Medbery Affiant. <br />GENERAL NOTARY - State af Neb�aska � <br />JAMIE MUES JANKOVITZ ` � ��� ����� i <br />s It�r Comm. Exp. May 25, 2Q14 � L��'� <br />tary Public c�� <br />PREPARED BY: ���✓ T� : <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY, ELSBERND, ANDERSEN, <br />KNEALE & MUES JANKOTIVZ, P.C. <br />202 West Third Street <br />P.O. Box 639 <br />Grand Island, NE 68802 <br />Telephone: (308) 382-2128 <br />