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901.600Z0Z <br />ry <br />CA <br />(,-) <br />r\) <br />17-3 <br />1-� <br />ry <br />7 <br />.ZZ) <br />Return to: Michael L. Johnson <br />Smith Johnson Law Firm <br />104 N. Wheeler Avenue <br />Grand Island, NE 68801 <br />Affidavit of Marital Status with attached Certificate of Death <br />AFFIDAVIT OF MARITAL STATUS <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />COMES NOW, the undersigned, being first duly sworn, and deposes and says those facts of <br />which she has personal knowledge as set forth hereinbelow and that the following information is <br />true and correct: <br />1. Name of Decedent: Richard A. Kohl <br />Date of Death: July 8, 2020 <br />Domicile at Date of Death: Grand Island, Hall County, Nebraska <br />Name of Surviving Spouse: Hilde Kohl, also known as Hildegard Kohl <br />2. Affiant is the Surviving Spouse of the Decedent. <br />ENTERED AS INSTRUMENT NO <br />