Laserfiche WebLink
Return to: Jamie Mues Jankovitz <br />202 W. 3rd St. <br />Grand Island, NE 68801 <br />AFFIDAVIT OF MARITAL STATUS WITH DEATH CERTIFICATE <br />nn <br />= D <br />171 v., <br />= <br />1(0 <br />Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the <br />undersigned knows the Decedent and the surviving spouse of the Decedent and that the following <br />information is true and correct. <br />1. <br />Name of Decedent: Delores L. Omel <br />Date of Death: April 16, 2022 <br />Domicile at Death: Hall County, Nebraska <br />Name of Surviving Spouse: Marion D. Omel <br />Date of Marriage: March 4, 1956 <br />2. The Affiant is the husband of the Decedent and in that capacity is familiar with the <br />marital status and the death of the Decedent. <br />3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. <br />4. Title to the following described real estate is held by the Decedent and the surviving <br />spouse in joint tenancy, to wit: <br />The East Sixty-five Feet (E65') of Lot Fourteen (14), in Block Five (5) <br />in Westerhoff's First Subdivision in the City of Grand Island, Hall <br />County, Nebraska, except the Southerly Thirty Feet (S30') thereof, <br />deeded to the City of Grand Island, Hall County, Nebraska, for street <br />purposes. (Physical Addr: 3204 W. 16th St., Grand Island, Nebraska) <br />5. As of the date of death, the real estate had an assessed value of $144,049.00. <br />6. The Decedent and the surviving spouse were married as of the date of death. There is <br />no Nebraska inheritance tax lien by reason of Nebraska Revised Statute § 77-2003. There <br />is no Nebraska estate tax lien by reason of Nebraska Revised Statute §77-2102. <br />FURTHER THIS AFFIANT SAYETH NOT. <br />STATE OF NEBRASKA <br />) ss: <br />COUNTY OF HALL <br />Marion D. Omel, Affiant <br />SUBSCRIBED and sworn to before me on this /7 day of Y Y? , 2022 by <br />Marion D. Omel, Affiant. <br />jese0101/1 NOWT - a Stolle <br />JAMIE MUES JANKOVITZ <br />My Coma. Exp. May 25, 2028 <br />PREPARED BY: <br />Jamie Mues Jankovitz, #20754 <br />BRADLEY LAW OFFICE, PC <br />202 West Third Street <br />Grand Island, NE 68801 <br />Telephone: (308) 382-2128 <br />jamie(a,bradleylawo f ce. com <br />'Notary Public <br />Page 1 of 1 <br />N <br />0 <br />N <br />CD <br />-3 <br />co <br />C) <br />—4 <br />in" <br />rri <br />Lin <br />Lel <br />x"7'1 <br />