Rev. ��,�i T 7E F RASIU- DEPAIt�'ME�iT OF 1#�.AL7'M AND �UMAN SIQlVIC6S FR+IANCB AND BUPb'QR?
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<br />i.OECEOENT-NAME 'FIR37 MID�LE � � ' � � � � :�. 2.BEX -- 3:OATE� TH (46rqIA(J/jsYtl� -
<br />Louie . NMN Sw�.��� Ma],e Au u�t 18� 20Q1
<br />4 CITY ANO 6TATE OF BIRtH fd rrof iv !/, 5A. nertre epuNry) 5a. � AOE� • Last BI�Nday ` UNpEq� t�YEAH -�� �� UNbER 1 dAY � & QATE OP BIRtN ��A� �j �/ -�"- � '
<br />Pilger, Nebraska n�B� 82 PW.MOS. � DAY� Se.MOURS� �$ AuguBt 15�, 1919
<br />7.SbCWl6ECURTIYNUMHFR � - � � Ba CEOF EATH . . . . � .. .. .- . . . "
<br />- � �H08P.ITM; In� OTHEH Hmu .
<br />. 507-20-2572 � - � ""�
<br />Bd. FArIIItY - Neme - " (��rofmsntullon g�vB saee! aMnumberJ . . � . . .. � �R Ou(peUeN � pqg�� � .
<br />St. Francia Medical Center ❑ �A ❑ �rs��
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<br />Bc CI7 Y TOWN OR IOCATION OF OFATH . 8d INSID$ C1TV LIMITS � 88 COUNTY OF DEATH � - ��'�' �� . .
<br />Grand Island v� ,�. yo ❑ Ha11 �
<br />9e t+E6itfFNCE•57ATE 9b COUNTY � ec.�ClT�'•TpW1�OpLt)CATIpN � � � � - �� 8d. &iPEETANONUMBE /6wN�np1lyCodp) � , ,�� @p Mt51DECtir�.d�a��;
<br />Nebraska Ha11. Cx�inc� .T�1�nd . 1204 E. 7kh � 688Q1 �r�. []X �[]
<br />10 RACE • le g.. WMte. BIacM Ameriean hidian. 1 i. ANCESTflY Ie.g.IlaAen. Me�e9�, �etmen, 4kl ��' 12 O MARii�m... �❑ HVIOOWEU 19 NAME�pP�$POUSE �' (I[wdd. �p�tlnyidatl�amol � � ~
<br />ek 1 iScec�F/) ISPecdy) . NEVER � QNORG�D � ..
<br />� White Am�erican : Madot�na �udrna
<br />14a USUAI.00CUPAIION 1��+'bkindo/xm�trdonseudrigmos� IAb�KMpOi �BqJ� 8' _� tRY � 16 EUUCAT�N �9plef(�i - W� ��
<br />O Ot wtMAdg kfa. Bven B rB��edl E�BmBnipry 0� $BCOndNY I0� t� ..,� , QOI�gp� �tA tr 9•1 �
<br />U Roofer Constru¢tion Unknown '
<br />� ?� I8. FATHEF+NAME � F6iST MIDOLE �AST ,. 17,. MOTHER,- � FIq9t � AQ6DLE �. ., , SU
<br />° � - Walter .. NMN . Swartz - ��Minnie NMN Unkuown
<br />� O � 18� WAS DECEASED EVEH W US. RRMEO f'6HCES9 198. INFOqMANT-NAME � �
<br />`y nee m unk I �n res. ene war end ea�es W aervieeel
<br />� ��A --- Madonna Swartz
<br />� teh INFORMANT MA0.1Na AD�qESS ISTREET OR R.F 0 NO, CRY OR 70WN. BTATE 21P► , � �� - �
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<br />°' 1204 E. 7th, Grand Island, NE 68803
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<br />I� hereby certify this to be a true and cprrec� co�y pf th��a�ii�ii��l �� �� ��t;���.,�� ,�� ��� ;.
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