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<br /> Recorder's Memo: Lots 12 and 14, B7.ock 26, Gilbex't's 'I'k�a.rd �ddition, City of Grand
<br /> Island, Ha11 County, Nebra�ka �'��
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<br /> WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASiCP, S7A�`TE`° `
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE �,'�RUE COPY
<br /> OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEP.�;�T�1�'T`4F,,HEALTH ,
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL-��PO�ITO&Y F`01��'�
<br /> ,�.
<br /> VITAL RECORDS. �,,-
<br /> ' . ..
<br /> DATE OF ISSUANCE '� �
<br /> ��d���
<br /> OCT 21 �87 STANLEY ;S:��GOOPER,,.DIRECTOR
<br /> �, .,.
<br /> LINCOLN, NEBRASKA BUREAU OF �I�"AI� ��TISTICS
<br /> �f�. 98' ��3�9
<br /> STATE OF NEdRASKA—DEPARTMENT OF NEALTiI
<br /> eUREAU Of YITAL STATISTICS 8� O��� p
<br /> CERTIFiCATE Of DEATH ��.�, ���a- ��
<br /> EOtN -N U If A _.. A M lAM..De�.1'r_! .�_. .____.
<br /> � Ivaloo iCatherine McCullou h �. Female June 2, 1987
<br /> f-1�.�.,w��. OM6M1/DESClNT(�.�.,Mdien,IM.i�e�, AGE-1.w U.�/.� UNM�1 1EA� UNOER 1 OAt DATE Of�1RTN(AN.,Dor,Y..)
<br /> Iwli�w.N�JfSp«ilr! OM��.Ma I f11���►1 /1'n.l MOS. • OANS MOUlS. MINS.
<br /> .. White American U ee. 74 ab. � k. � �. Octobez 13, 1912
<br /> A A/E �M�w Y.S.w., 1 [N W11AT COUMTR�/MA��IED.H[VER MARMEO. NAMt Oi S►OUSE(N.ib,oi.�weid�w wo�w�)
<br /> ��w��� wI00wE0.WrO�CED(Sp«ilrl
<br /> Barnes, Kansas �� •. U.S.A. ,c. Married ,,. Carl G. McCullou h
<br /> IAl SECURIiY NU OCCINA (GM►i.d el.�d dew�dvriwy�w� ��MO Of�USINESS OR INW3IRY COUNTY Of DEATM
<br /> d.r�iw�Ii/�.�ww i!rNi•�1
<br /> ��. 506-09-4536 � i�omemaker i� ��b. Own Home 9ri/ ,.,. Hall
<br /> C11r,iOWN OR 10CAT OMM INSIO!CIT1�UMITS MOS►ITAI OR OfNER INSTITUiION-Mew�(M�M�w��1Mf• q M�M.a���wSi.W:��00�, '
<br /> !s�«ch r..«Ne� yiv��MN ewd n�1wM�) O+M�M+�/f�r. �..MN�«.�ff�wilrl
<br /> � . Grand Islnnd �k. Yes ,.d. St. Francis Medical Center ,... In atient
<br /> M�IOENC!-S1A/t �011N1r CIT/,TOM�N OR IOCATION STttET AND NUM�lR IMSIOE CITY lIM1iS
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<br /> is.. Nebraska i� Hall �k. Grand Island �se.2003 N. Huston �s.. Yes
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<br /> Geor • NI�1 Wiechman Elizabeth NMN Haberkamp
<br /> w�s oece�s�o evu�H v.s�weo rwcesr INfORMANT-MAMf-R(UtIONSNII-MAIUMG ADO�ESS (fTt!(T W f.i O NO..C�T'M TpWK M�I[��N!
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<br /> u. No I ------ �rCarl McCullouRh�sband 2003 N. Huston Grand Islan Ne.
<br /> �URIAI,G�nwrien,b CE/�ETERt O�CtE/Mt011r-NAME IOCATION CIT1�OR TOWH STATE
<br /> „,.. Burial �a►June 5. 1987 �o� Grand Island Cit Cemeter �os. Grand Island Nebraska
<br /> R-SIGNA U NO. IUNE�AI NOME-NAME ANO ADDRESS ISf�tli O��.1 O.MO.C�n'W�O�MN,SLtl,IIQ 68801
<br /> � � ` -�J,S� �,Livin ston—Sondermann 505 West Koeni , Grand Island, Ne.
<br /> DATt p OtATN(M�,O�w►..) D� E N (Me.Oe�,Y../ NOUR Of O[ATN
<br /> i`�'
<br /> � :�. 2 Jttr� 1987 �i�� :.,. �•s. M
<br /> �� A 1 M (W�. /. . N V DUiM =� ��ONOUNCEODEAD /RONOUNC[ODEAO(Meur)
<br /> .. :is.9 June 19$7 _ � 9�.53 _ t;t s r�.,oa,.r..� - __ `
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<br /> AND AODf! t Ef' YSK�AN O�COUNiI'ATTORNEr)(i�p�a�Inn�)
<br /> � Wn. J. Ltswton, M.D. P.O.Box 550 Grand Islan:'., *le. 68802-0550
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