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State of Nebraska ) <br />ss. <br />County of "all ) <br />Francis H. Purdy, after being first duly sworn upon oath <br />deposes and says that he is a licensed embalmer in and by the <br />§tate of Nebraska; <br />That, on October 5, 1955 rranklin Larchick, a resident of ° <br />Grand Island, Hall Uounty, Nebraska, did die and that he did <br />prepare his body for burial on that date; <br />That on October 6, 1955 he did supervise the burial of the <br />body of Franklin Larchick in Grand Island Cemetery located in <br />Grand Island, Hall County, Nebraska; <br />That, he did see the dead body of Franklin Larchick and <br />did positively identfy same. <br />Further affiant sayeth not. <br />Signed at Grand Island, Nebraska t1 a day of November 1955 <br />affiant <br />Subscribed and sworn to before me, a notary public, on this <br />3 day of Nebember, 1955 <br />>WWII tilt,+, <br />i <br />CQ��is bn expires October 5, 1960 <br />couJAISs <br />Filed for -record September U•, 1958, at 10;10 A.M. <br />Register of Deeds <br />Hall County, Nebr. <br />