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v • + <br />s <br />ST TE OF NEBRASKA) <br />ss• <br />COUNTY 4F , ) x <br />V t 4 b <br />after being first duly sworn on oath deposes <br />an says that he is'a resident of Grand Island, Hall County, Nebraska and that <br />t <br />he is a licensed embalmer and funeral director in and by the State of Nebraska; <br />That, Sarah Jane Johnson , a resident of Grand Island , Nebraska <br />did Idie at Grand Island, Nebraska on April 11, 1962 and that he did <br />pre. )are 'the body of Sarah Jane Johnson , for burial on that date; <br />That, he did supervise the burial of the body of Sarah Jane Johnson <br />in gwj- j!emorial Park cemetery, located'in Grand +Island, Nebraska <br />on A,ji 1962 . <br />That, he did see the dead body of SarabJana Jo 1nann � and <br />did fgsitively identify same'; ' <br />Further affiant sayeth not, <br />Signed at Grand Island, Nebraska this 14th day of April 19 62 <br />Ile`f <br />Affiant <br />Subscribed and sworn to before me, a notary, public, this 14th day of April <br />19 <br />,,t <br />ti <br />Notary Public, <br />'3�iMe issi.irz- expires o,.t. 5. 1966 <br />71R. ��� filed for record, at3� M. in Bock j ui7, Page is- <br />,Begi1S of of Deeds, ELM GOIJA , f,&da Ja, <br />s <br />P <br />