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A F F T I A V I T <br />f <br />f H <br />James Livingston, after being first duly sworn, <br />on oath deposes and says that he is a licensed funeral <br />director and embalmer in and by the State of Nebraska; <br />That, he did prepare for burial the body of Ray <br />A. Kozal, who died at Grand Island, Nebraska on Sept. <br />26, 1954 and did supervise the burial of the body of <br />Ray A. Kozal in Westiawn 4emorial Park Cemetery, located <br />near Grand Island, Nebraska on Sept. 28, 1954; <br />That he did see the body of Ray A. Kozal and did <br />positively identify same. <br />Further, affiant sayeth not. <br />Signed at Grand Island, Nebraska this X <br />da-1, of <br />affiant,, <br />Subscribed an sworn to before me, a notary public, <br />on this FZ—if---day of <br />2z22k� <br />notary public <br />My comma ssion expires <br />x, -.00- <br />0 Q <br />Filed for record June 24, 1955, at 3:50 P.M. (11-21.22., Register of Dee <br />Hall Co... Nebr <br />
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