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Dent ) died on the insert name of deceased person day of at 2. , 20 and insert location of death. That the Decedent and insert were duly and legally married at the time they acquired title as husbandand-wife to the following described real estate: name of Decedent s spouse Legal Description: 3. That the marital relationship which existed between them at the time they acquire title to said real estate remained in effect and unbroken until the date of the decedent's death. 4.

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