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4 <br />AFFIDAVIT <br />AL <br />+t MIA 8 <br />6 <br />STATE OF N P$R' SKA i <br />a s '?`lam ° b "Tot"1 <br />11- X ft aAja 11"Voc c <br />4 COUNTY OF HALL )ss <br />of _ , .. _„. _County) Nebraska <br />8 <br />bei first duly worn union h oaths de oses 'and says that he s <br />then 0wae0v he <br />1 That he licensed embalmer and funera director in and foxy the <br />State of Nebraska <br />That he knoirs of hi own knowledge that �+` - .�. ` <br />departed this life on -_ _ �9 in <br />)* k -_ — <br />That he pr ar do for bUrljjal services were handled by the <br />Funeral Home under affiant's <br />per nal supervision and direotionj ,#nd the bow was buried on <br />Cemetery. <br />i 01'r <br />} l ea -and sworn to before me this 16" .,� day of <br />� 7� <br />3,%114 <br />4�ez t <br />"• a R ^a' w CAA � sx <br />lie <br />Comm 15 z rr`iexpires (— <br />state of Nebraska <br />County of a alt <br />EL te:cd on j *,umerscal Index and filed <br />for record m c.ff ca of Register of <br />Lecds's 66th _. d y of <br />April � . at <br />o'clooc and 45 in notes o..M. <br />and recorded in Boos 1 of <br />y�at age • w <br />egcater o � eeds . . <br />By........................... <br />- 1 =�2�.. • <br />Deputy <br />Fees <br />At'�' <br />