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rn N� 2C1p 0 n N .. CJl mmemaw CA CO -, r -- i 'S Cr) T rn 2 C7J r CD J Return to: Denise Myers P.O. Box 505 Cairo, NE 68824 AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ) ss. COUNTY OF HALL COMES NOW, 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 following information is true and correct. 1. Name of Decedent: Dennis V. Wells Date of Death: August 7, 2019 Domicile at Death: Cairo, Hall County, Nebraska Name of Surviving Spouse: Kimberly A. Wells Date of Marriage: June 20, 1987 2. The Affiant is the attorney for the Decedent's spouse and, in that capacity, is familiar with the marital 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: The Westerly Five Hundred Thirty Seven (537.0) feet of the Southerly One Thousand Eight Hundred Three and Forty Eight Hundredths (1,803.48) feet of the West Half of the Northwest Quarter (W1/2NW1/4) of Section Twenty Nine (29), Township Twelve (12) North, Range Eleven (11) West of the 6th P.M., in Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $209,322.00 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. FURTHER Affiant saith not. Denise D. Myers Subscribed and sworn to before me this 1a- day of September, 2019. GENERAL NOTARY • State of Nebraska Op SUSAN R. MRKVICKA My Comm. Exp. June 8, 2021 NX\A-Y--sai Notary Public N 0 f•"' 0) CS) CO s