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Return to: INS 1O1b OF 389 A s } H CASH — CHEC-0: REFU CASH__.— CHECK_._.___— Ni D T' NE t016 _.0 2:00 REGISTER OF DEEDS Colby R. Collins 3548 Schroeder Ave Grand Island, NE 68803 AFFIDAVIT OF MARITAL STATUS WITH DEATH CERTIFICATE Comes Now, the undersigned, being first duly sworn upon oath, deposes and states that the undersigned knows the Decedent and is the surviving spouse of the Decedent and that the following information is true and correct. 1. Name of Decedent: Tommy Ree Collins Date of Death: July 16, 2026 Domicile at Death: Grand Island, Hall County, Nebraska Name of Surviving Spouse: Sonya Jane Collins Date of Marriage: November 26, 1967 2. The Affiant is the spouse of the Decedent 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: Legal Description: Lot Thirty Two (32), Jeffrey Oaks Third Subdivision, in the City of Grand Island, Hall County, Nebraska (Physical Address: 4005 Norseman Avenue, Grand Island, NE 68803) 5. As of the date of death, the real estate had an assessed value of $320,033. 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 §77-2102. FURTHER THIS AFFIANT SAYETH NOT. STATE OF NEBRASKA ) ) ss: COUNTY OF HALL ) SUBSCRIBED and sworn to before me on this ht y of Au5k ..e -4 Son td, 1. Co 11; ns , Affiant. PREPARED BY: Colby R. Collins Telephone: (308) 380-2574 3548 Schroeder Ave. Grand Island, NE 68803 , 2026 by Notary Public sfNERAI - State of Nebraska ECHOCHO A. ALCORN . *Comm. Exp. Mardi 21, 2030 Page 1 of 1