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A F F I: 1; P V I T <br />STi TE OF NEBRi�SKA ) <br />SS. <br />I COUNTY OF HP-LL ) <br />R <br />Jui:.es Liviigston of Grand Islam, Hall County, NebrGs�ka, being <br />f irst duly sworn upon his oath, aeposes �..ud says that he is the <br />owner of the Livirngsto.Li- ;,onaerivarui Fufleral hotue of Grand Lsl&nd, <br />`a rill County, Nebraska; thLt he is a lice_isea erubaluier anc: funeral <br />director in ana for the State of iebraska; tYhGt he knows of his oven <br />knowledge that Emil x)oltz died on October 6, 1954 in Grrana l;Tana, <br />ball County, Aebraska; that he prepared the body of said Boltz <br />for burial and dia supervise the burial of said ErAl Boltz in Grand <br />Islam Cemetery, Grana lslaaa, Hall county, Nebraska on October 9, 1954• <br />Further affiant sa`,' eth not. <br />bubscribea a 1 .ia sKorli to before me this /, aay of _ ����, 954 <br />------ - - - - -- <br />�NOT,,RY PUBLIC <br />My aD mmisision expires <br />CZ <br />� • .w1 <br />Y <br />ti ' � •� wuN <br />::OrSMt .10 °� <br />..1 .. 3': rDl <br />- November <br />in Book .2..._ .._.. of <br />MisceLl._ at page._ <br />F:egister of i ends <br />By----- - - - - -• - - -- <br />1..5 <br />Fees � -- <br />