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<br />'' tn�YHEN THIS COPY CARRIES TSE RAISID SEAL OF THE NEBRASRA STATE
<br />bEPARTMENT OF HEALTfl, IT. CERTIFIES THE BELOW TO BE A TRU� �CO�'�..`
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMEN,�,OE";H�Z'H
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEP�SI��RY .�
<br />VITAL RECORDS. �', ; �
<br />1 � �-
<br />DATE OF ISSUANCE .�� '. �j ,
<br />� v����R� .
<br />AU� 3� 198� 2 0�. 2 0'7 2 2 3 ST�.� S. �oo���,::D���oR� �,
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<br />LINCOLN, NEBRASKA BUREAU OF VITAL Sfi�4�3S���S
<br />STATE OF NEBRASKA-DEPARTMENT OF MEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIfICATE OF DEATH p, �,
<br />VC6LVCIYI—IVA1wi r�wa� wuvuac �wa� cw n�c vr rc..... �..w... ....�. ...i
<br />, Renneth Alfred Peirce z Male � August 21, 1988
<br />RACE-(e.y., WhiN, llack, AmMican ORIGIN(DESCENT(�.o., helien, IMaican, A�iE-Iaa unAder UNDER 1 �EAR UNDER 1 OAY DATE Of lIRTM (Mo., Do�, Yr.)
<br />Indien. 1e. (S�eiirl �^"�• �.) (SPKNP) (Pn.l MOS. � OArS NOURS . AUNS.
<br />�, W�►�te American a�/ b ,. 67 �_ ; � � Nov 4, 1
<br />CITI� AND STATE OF lIRTN (N ne1 ie U.S.A., CITIZEN OF WNAT COUNTRr MIARRIED, NEVER MARRIED, NAME Of S►OUSE (II rih, piw maid�n rro�a)
<br />= nee� eeunlrrl WIDOw OIVO E(Sp�ci/r1
<br />= e. Sidney, Nebrask q , U.S.A. � l�arr�`e� �� Ruby I. Boatman
<br />--- ---- - - - ----
<br />- SOCU11 SECURITY NUMlER USUAI OCCUYATION fGiw kind olwo�k doM drriny me» KINDOf SUSINESS OR i DUSTRT COUNTY OF DEATM
<br />_ �r.n.4�� r ,... ; ,.►� � Fi one T�re &
<br />=,,, 506-18-6943 ,�,, B �ec�anic 1 3 b K uU�er Co. �� Hall
<br />CITr, TOWN OR IOCATION Of DEATM INSIDE CITY IIMITS MOSPITAI OR OTMER INSTITUTION - Naw� fl/ no► in �ifMr. �F IWSt. OR INSi. I�dket� OOA,
<br />- �Sp�ei Yy or No) piw M rl a��H�. e+.. InpenMe (Sp�cJp
<br />„ Grand Island ,.�. �'es ,,�. `�g"+��+""�. Wheeler (Home) , ----
<br />RESIOENtE-STATE COUN1r CITr, TOWN OR LOCATION STREET AND NUMlER INSIDE CITr IIMITS
<br />_,�,. Nebraska , H all � G Island �,�. 1404 N. Wheeler �� '
<br />------ - - -- -
<br />— i1TME!_N�YE --- — iIIST - -- -- W�M l�S Y[fTMi!_Y�IDiN N�Yi 1lST MIDDIE - – --- ---- LLST
<br />�� _ Alfred Bennett
<br />— wA3 DECEASED EVER IN U.S. ARMED FORCE54
<br />(rw. �e. m unY) I! �w, iv� r ef )
<br />1e Yes: �i-1� 4� �-��-+�
<br />BURIA4 Cramafion, Removal DAT
<br />Au 24 1988
<br />Burial �' '
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<br />$ z�.
<br />_ s DATB SICNEp (Me., 1
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<br />_ � 23b.
<br />_= Te Nr Ma d q knowb
<br />_ F w�w(d alawd.
<br />_ 13d.lSiq�w� ead TiN�
<br />NAME ANO ADDRESS OF C
<br />l �t C. Church
<br />Peirce I�� Edith � Ora Wassum
<br />_-- - - ----
<br />INfORAAANT-NM/E-RLUf10NSMIP-MAIUNG ADDRFSS �e[i w e.r.o. No. cm pl SiATt tnf
<br />19 ltuby I. Peirce-Wife-1404 N. Wheeler-Grand Island; NE.
<br />CEMEiE�1f OR CREMATORY-NAME LOCATION CITr OR TOWN STATE
<br />�. Westlawn Memorial Park �. Grand Island, Nebraska
<br />FUNERAL MOME-NAMf AND AODRESS (3nttt O� 11.f.D. NO., otll O� �OwN. StATe, iv1
<br />Q,pfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE. 68801
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<br />Grand Island, NE 68801
<br />AU6
<br />Y7. IMMEqA7E GAUSE (ENiER ONLI' ONE CI�SE iER IINE FOR (arJ, �b), AND (c)) i leM.sl b�waw aun oad dwM
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<br />DUE TO, OR AS A CONSEOUENCE Of: i ���rrrd Mrw�n aw� osd d�aM
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<br />DUE TO, OR AS A CONSEQUENCE OF: � law�wl bNwM ane� asd d�eM
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<br />ACCIDlNT. SUICIDl. 110AVCiDl. �UNOfT;, DATE Or II�IUlY (Ma, De�, Yr.) MOUR O/ �WUR► DlSCtl�! MOW IN1U� OCCUMfD
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