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IIrnsrrlvsl ERv.r-a. BTAT!OF N�gE,1 - . <br /> DEPASrRn1T of tuauC HEALTH DWAEi7HCNT OF HEALTH <br /> • <br /> mVCATIlH1 AND Wi1lp2E mYw ef Thal Iteittetkos <br /> BIRTH NO. 124. CERTIFICATE OF DEATH Sr/TS nLS Na <br /> L P4Ct O7 DtAT5- -L i I Al.HEADENCS(NY..d. 4 L.i H Madam�.Ihoti: <br /> A coCtITT I!a <br /> loll.__-___ �A� Nebraska .°WNrT Roark" <br /> .CAT(D err..t..l.S=SA..A.Boob t.L EN G T H OF I .CrrT lit ar.(de *Ws..rb SUSAL) <br /> .rolliN Grand Island ..TAT .Ian Grand <br /> \-a POLL NAME OF III am 1.S..ltal r...a.tl...E1..r.r.a arm .at.o.•■1..W.O.) <br /> s:,__HOST1TALONE 1021 nest 4th Street��)�j A1Dm_ 515 North Adams <br /> i r_ L NNAAOS OF ..IHr.D \IHIdY.) e.(L..) 1L PATS (N.SA) ?Dv) f <br /> ITy..r Pt1..1 Minwe Poehler TRApr1l 21, 1Nba j <br /> L SIM L COWS..SACSI7.MASR ED.NEVER MARRIED. L DATE OF BIRTH L A02_/I. U 0..I Tr.H Weer w Hw <br /> Female KhiLa ! �°°IY DIVORCED j°°`D''l-24-1875 1 H-• D•r• H_.I Hr. <br /> } I.a IFAJAL oCQOATION Im ..W r owl IL AN RM.,OF MEMsrs=l Dw.MTH MIR tows or. (SEE y ILC gip!WHAT I PLACE .r hedge 1 �v i_Wt.: e YO w) Home styhajen,§ermany <br /> i I <br /> IL FATHER'S NAME 1144.Norma'S HAMM NAYS 1t.NAME OF HUSBAND OR WOE <br /> .1 Lohman I (John H. Poehler <br /> i <br /> : LL WAS DECEASED I:FER/N I t ARI®sORCE{t 1 IL SOCIAL SBL9SITT I1.IRPOEHANrI NAUE v S1. •••••••O. ' <br /> 33 ii IT. «....w.1H sw dl..wr o dNr.t..tW1 M0. <br /> so Mrs. Henry Werner <br /> I IL CAUSE OF PLATHI 1101MacAL ournnomscuty common bl.1.° ar...I ` Omit BN.N. <br /> E..ter W.OI..M MI L DIREGT1.THELEADING TOO DEATH• C /L I gSGN. Orlt r_I�ty►t <br /> w�Qe O ATM .q�u�`A,'/.aly /7,fy <br /> r Lb4 I ANTSCEDENT CAUSO DoH TO n)^,r �e mod/ o liP�.tV 1 La...�. <br /> 1....+,ry I, <br /> ... n Y.dlt-j �y.ame a L4.OWES PUS TO (rl e. .c s K t <br /> . . I .''::•...TL`: SAL __..F.�u fit _ X:..✓i1;: , <br /> tit O ,` 0 I OTHER BONOICAHT OOMCE7TONS <br /> le I!I...DATE OF OPERA_.(I.MAJOR FMDINOI OF OPSHATTGm <br /> I //M4 11TWo IL wvrotstr s <br /> TIER IS..(1r) n.PLACE OF H1euaT 1��..EE...1.et a.. Oa/CITY OR TOWN OOUNTT, ( <br /> LIDS (..../.t..l...P . • ' i.HWIt 11.0 it JS? Ale/ �rAf-:� .• <br /> T(a TIRE tows) (DaW 1T.G.r)�/1INO H4ORT Di.HOW Dm . t �y Arm ru8+.; -,7.,i A. N.t WW. - ' Pk.t/ T Flee <br /> IL!hereEF Corti/2 My I Rtt tI.&MMMetf/rauL_.L ..,if 4 f! <br /> L,� ytthe a , O w1r:I <br /> owed -. !_-�ERN/tMt OW*aoartNat.j. R..e hew.fA/darEeE elm the amp epb�/� - 1 <br /> tea /�. !. 1wo.y�rr) Imr 7 N1 l .�w.F'_ <br /> us. ,' a Dim ) eta OF AL T76 +w s�'' <br /> • CROIATI <br /> HOLOTAL-nom) 4-24-le 6 hi/lips .Phi lips gli..; r, . <br /> e LCD It LOCAL .Em. R .[ :.: <br /> ■ <br /> 1 - , <br /> : <br /> 4 <br /> Issued Mgr 9. i950 <br /> ' <br /> I <br /> 1 <br /> =9 <br /> iw '/y� /(�2 _ / / — / - q <br /> el. J `f r - / - <br /> • <br /> State of N4raska } <br /> 5.2 <br /> Ct unty of iia'1 , <br /> Er.t-red N:t)rie-icai ..:de;i and filed <br /> fc' re,_(::,-" . . :fti-c, 1 .\cg-.- of <br /> •U , -. . J0_ 5s. <br /> . e ,u, t}__N'. <br /> tere• e <br /> i <br /> , .'c;,z",,._tr _,i Jeeas• <br /> ty . ,, <br /> Fees <br /> �� -11'F(L et uty <br /> CP,a.t.„ , 1,_.9---,--,-----4- 4-17 11 . <br />