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AZ 4Z <br />State of Nebraska ) <br />ss. <br />County of Hall ) <br />Francis Purdy, after being first duly sworn on oath deposes and says <br />that he is a licensed embalmer and funeral director in and by the State of <br />Nebraska and that hE: >is a resident of Grand Island, Hall County, Nebraska; <br />That, on December 30, 1958, John Schwartz , a resident of Hall County, <br />Nebraska , did die in Hall County, Nebraska; <br />That, on December 30, 1958, he did prepare the body of John Schwartz for <br />burial; <br />That, on January 3, 1959, he did supervise the burial of the body of <br />John Schwartz, in Grand Island Cemetery, located in Grand Island, Hall County, <br />Nebraska; <br />That, he did see the dead body of John Schwartz and did positively <br />identify same; <br />Further affiant sayeth not. <br />Signed at Grand Island, Nebraska this day of 1959 <br />v <br />v affiant <br />Subscribed and sworn to before me, a notary public, on this day of <br />. 1959 <br />p <br />notary public <br />s� <br />I"j'y :xa�imn�,.s�on expires � <br />J. <br />,y <br />r <br />
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