|
^, � a. . � �
<br /> r:� , ,
<br /> ;"3 � -=''
<br /> , g
<br /> � ('� `r .'� '�' �. D �,
<br /> �
<br /> � � � �U { ?•' � �.
<br /> l.. y � �� C�'� �/'1 �1
<br /> � a � � �*." �'�* fD
<br /> � � � -� � �"'�V'
<br /> � � fTl
<br /> � -� -t Gp �'
<br /> ,-1 ? � �--, � � � '���',
<br /> t-' � ,- -� ''� � N-�►.
<br /> fTl ' � �
<br /> � � E�, «
<br /> a �'' � r- � o �
<br /> �(7 r�lj � � ,r�--- -27 � S-=
<br /> Z"+ �
<br /> 7 �'� V�
<br /> Q n ��h � � � �
<br /> C11 "`"'� Z .
<br /> _ � � � 0
<br /> C✓'i
<br /> LOT THREE (3) , in BLOCK SIX (6) , in H.G. CLARKS ADDITION TO
<br /> THE CITH OF GRAND ISLAND, HALL COUNTY, NEBRASKA.
<br /> ���
<br /> ��� iE�4�'7�
<br /> ��� �.
<br /> WHEN TI�S COPY CAIbZ1ES TF�RAISED SEAL OF THE NEBRASKA HEALTH AND HUl��CE3`=-_^
<br /> _ SYSTEII�IT CERT�S TFIE BELOW TO BE A TRUE COPY OF THE OR/O/NAL RECO��=_�_�
<br /> THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM,VITAL STAT/ST/CS S���J�I l$_:�-=>_
<br /> THE LEQAL DEPOS/TORY FOR VITAL RECORD3. -:_�'�'"�=� _ _
<br /> DATE OF ISSUANCE � _ : _
<br /> �1����U�i�1�Y�COOPER :- _
<br /> MAY 12� 1998 ass►STA����� = __
<br /> L/NCOLN,NEBRASKA HEALTH AND HUMAN S���- =
<br /> ___ _ _ _ _-- _ �:����
<br /> = -- - : � ,
<br /> _ __._,
<br /> 3TATE OF NEBRASKA-DEPAH'i'�ENT OF HEALTH r
<br /> B�reso of VIW Statistia
<br /> � CERTt FICATE OF DEATH �3d 0 s�?1 0 4 5 7 4 -1.
<br /> O E G E w S E D—N�w f r�n* .wou uii � W►TE Of DEAM �rowiw,���,re.��
<br /> '� e �� Fem x r 26 1 1
<br /> RwCE.�.ra.waw..reNUw wwuM, �GE—usr w.w��n.. u.ee.�e.. oATE Of NRfN�..wrN. aw�. cOUNTt d DEwiM
<br /> eK. i trKr�� M�MOn1 1�Mfi 1 �wa. o��f MOwf rr+. ��
<br /> � fa A. 7�. �. �2z� ia H811
<br /> G11f,TOvNJ.O� ��OMI OEwiM rsr�anr ur�n 11p6�1G1 OR OiM�NS �r ww w u+.r�,ow��*�y+o�wwe��
<br /> wcisr ns w.w
<br /> � eb �.. �. cis Hos ital
<br /> SiATE af NRM�M wor«�.s�..wr�UTIZ@!Oi wl1AT COUtiI�T M�R�IEO.NEVE!M�EO. SURVIVNG SPOUSE i w ww,aM woe.�wr�
<br /> cow�n� wDOWEO.DIV0�0 i r�tn�
<br /> '� +• a. a ed ��. t�talter P, tllzite
<br /> SOC1Al SECWIIY M�ER USUAI OCQNATIOM�OM[�+O W rr0�oo.M ouaw6 rou p KM�D Of�tlSNESS OR M�DUST[T
<br /> rOtM YI��N!N M K/Mr 1 �/
<br /> 12. 1�.. `i�� Is. C[Tle �q
<br /> �E5IDENCE—SiAtE COtJNTY pry,TOMT1,OR 1OG110N ■.w an w.ns SiREET �wD t+�
<br /> i s►RC+n ni a no. �
<br /> � �a. �.�. i«. I �w. iw. 61 W lOth
<br /> twtMH—qA6�E rMp �� up MOil1E!—MAlDEN NAME ryfr .wx� wr
<br /> 'f� � -gt -- Tham son
<br /> IN/ORMANT—NAME—tElAf10/tSMN �uIING ADDIIESS ��eer w�.ra.Mo.,cm w row.,u�a,tr� �
<br /> "` e �� � Gr sland Nebr. 68801
<br /> run �. oum wws cwusEO�r, ��rER d+tr a+E uusa rc�tr+t ro��e�.�s�,�w��y �••" � y �
<br /> u. c.�r�
<br /> �[11MlM OMfft 4M0 Ot�M
<br /> ���� h' � � �
<br /> - rimar
<br /> . �
<br /> �o«.n�o....�..�., ;
<br /> .»,�M a... .�..b n� �
<br /> �...e«•n c.ru w, w�ro.w•�•co..�ow..0 a� �
<br /> � �1�TIMO tM� YMOl�-
<br /> u�wa uvw un
<br /> kl �
<br /> �
<br /> ���f10++M�CANT COMO�tq�coNOrT�ows ca+rMwnNO ro D�wn��uT�+ol auttc rwar r.r rtw►t!,wws rMeee A AUiO►ir 7i TES w�ae r�»s�MOf co..- �
<br /> MtGN�I�Ct M 1M[�AfT 7 MONMSI I�ff O��r0� YpflC iM WilWIMtwO CwYf! �
<br /> a w�r�
<br /> •!S.7 NO O 1A.110 IN. �
<br /> AQCIflEM.SUKbf,nO�YC1pE. �ro..rM,y�,n•�r qpW IH1NR� OCCURREO ����wnrw or�wwn�w rur�«rur u,mr i��
<br /> OR UNOETER�+�NfD�vean� .
<br /> 7r. �N.
<br /> 70�. M. !Y. t:
<br /> tMlUl�/Ai WORK RACE p NJUR�.i«ar.�.w,frwr,r�wr, IQC�i10N �imn w�.r.o.�.o.,cm o�ro.rw,s.�n� s,
<br /> 1 fnun ws a�wo� ow�n�uo..�u. �wawr� �
<br /> ?w. 7r !�. �
<br /> :
<br /> ��AT�1� rONlq Y� t�Y nW/M O.lt t!Y AMO lA1f LY IM��MN YM OM /OM/OM NDt VN1�I M Q[A1►1�C{11R�� 1i 11e�►ti�i.ON HI� ti
<br /> �MtlKInN: MO��M Mt RY WOt hI1N 0l11M. Iw01N1 •
<br /> �wmr�wo r«� i0 wn.uo,w iw ru
<br /> Ila MC��NC MOr � ' M r�[rOw�lOOl.Ouf $
<br /> {�' ttt fl�. 11� f7�. M.ro n.e wne�s�fano. !
<br /> CEtT1FICATION— � O�OMER�w n�e�.�n e•ew wow or a.n�� a oec �r.aa no.�ou.�cto oe�o s
<br /> •u.w.ew a w�e w�►Mw/o�n�wnts�a�tw�+,„+w o►�w�o.., ro.nN o�t nw� �ow �
<br /> r�•n�onuww w w a�a ra eu�a�w uus��u funo.
<br /> ri. r
<br /> ccm�—wwt....�e.....� � m. o M. .`' �
<br /> . o�aex o.on ..w,
<br /> 77�. D JA. l7�. '�
<br /> MAllM1a AOD�ESS—CERiK[� sruir w:.r.�..ro. n at r„au u.K L A :
<br /> � 2 W st Gr land Nebr. oo `
<br /> W�IAI.AEMAt10N,�EMOvAI EMETEIhi OII CREMATORY—WAA�E l 110N c�n w+ow�. p�n �
<br /> 1 NKrr�
<br /> "'. " "'. �.. ebr
<br /> TE �uo.nw.w�,ny� fUNtRAI MOA1E—NAGfE A►iD ADDitESS �NNft O��.i.i.w0..Gm O�pwN,srwn,t�r� �
<br /> �'� - �� - Wa on Grand Island Nehr.6E801
<br /> ...... � , . �..... _ �...----- -�--� --- .
<br />
|