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At 1Z <br />i <br />A F F I D A V I T <br />State of Nebraska) <br />County of Hall ) <br />r James Livingston, after being first duly sworn, <br />on oath deposes and says that he is a licensed funeral direc- <br />tor and embalmer in and by the State of Nebraska; <br />That, on 'Feb. 12, 1955, he did prepare the body <br />of Clarence Otis Smith', who died on Feb. 12, 1955 in Grand <br />Island, Nebraska, for 'burial; <br />That, he ,did supervise the burial of the body of <br />Clarence Otis Smith in Westlawn Memorial Park Cemetery, located <br />near to Grand. Island, Nebrakka, on Feb. 16, 1955; <br />He did see the 'dead body of Clarence Otis Smith <br />and did positively identify same. <br />Fur.ther,,affiant sayeth not. <br />Signed at Grand island, raska this 19th day <br />of February, 1955. <br />R <br />Y t % <br />\\ ,�Ri�i +'�►rr„p���,'u�ubs crib ed and sw rn L _/before me, a notary public, on <br />a <br />k``' f` <br />,, •����,. y ti� <br />y f day o l <br />__ -- <br />'cornror o,,+, .� -- notary public <br />Filed for record April 13, 1955, at 10:30 A -M- <br />Register of VBeds <br />