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�� <br />��� <br />� <br />�� <br />0 — <br />.� �� <br />.� � <br />0 <br />� - <br />� - <br />� - <br />d� <br />� <br />� <br />�� <br />� <br />..� <br />,i <br />i �� <br />, _! <br />f 1 � ' �� <br />j �� <br />�; � <br />1 <br />�� <br />aY1r <br />�� D <br />r <br />r <br />� -'�-_ <br />� . <br />m _ <br />� . <br />� . <br />�-i <br />f'+7 <br />� <br />o �� <br />''� c'� <br />O `� <br />c�'! <br />0 <br />�. <br />r.s <br />� <br />r--.. <br />O <br />7 <br />� <br />H <br />� <br />� <br />�� <br />f"�'� <br />� <br />--�1 <br />201107'75G <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />AFFIDAVIT OF MARITAL STATUS <br />) <br />> SS. <br />> <br />� :fJ� <br />Q --� <br />C A <br />Z -- 1 <br />—{ R1 <br />'� C� <br />O "�'1 <br />-'' z <br />� t*� <br />� � <br />1 "" � <br />r m <br />c� <br />...e... <br />� <br />� <br />COMES NOW, the undersigned, being duly sworn, deposes and says that the undersigned is the <br />surviving spouse of the Decedent and that the following information is true and correct: <br />1. Name of Decedent: Carol Louise Fuller <br />Date of Death: November 14, 2006 <br />Domicile at Date of Dea.th: Hall County, Nebraska <br />Name of Surviving Spouse: Donald D. Fuller <br />Date of Marriage: June 26, 1954 <br />2. The Affiant is related to the Decedent as follows: surviving spouse. <br />3. There is no Federal Estate Tax, Nebraska Inheritance TaJC or Nebraska Estate Tax that is due because <br />of Decedent's death. <br />.��; <br />.,,'�"� <br />.. C'� <br />#--� <br />� <br />�� <br />-�.7 <br />� <br />�:7'I <br />� <br />�5' ,' D <br />4. Title to the following described real estate is held by the Decedent and the surviving spouse of the <br />Decedent in joint tenancy, to-wit: <br />Lot Eight (8), in Block Twenty-Five (25), in College Addition to West Lawn, <br />in the City of Grand Island, Hall County, Nebraska <br />5. As of the da.te of death, the real estate has a fair market value of $63,272.00 <br />6. The Decedent and Affiant were married as of date of death. There is no Nebraska Inheritance Tax <br />lien by reason of Nebraska Revised Statutes Section 77-2003. There is no Nebraska estate tax lien by reason <br />of Nebraska Revised Statutes Section 77-2102. <br />FURTHER AFFIANT SAITH NOT. <br />/' �, <br />•I //i`�/ l .�� i i_ � ��� <br />I�i. � � - <br />SUBSCRIBED and SWORN to before me this � da.y of October, 2011 <br />r <br />� GENERAI. NOTAi�I -StatB CE N�►teska <br />IY� Comm. ExP• M�1 2014 <br />�r Return to: <br />Galen E. Stehlik <br />P O Box 400 <br />Grand Island NE 68802 <br />� %�, <br />ary Public <br />