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<br /> gE; LOT 7 IN BLOCK 15 IN WH�LLCOUNTYENNEBRASKAHIRD ADDITION TG
<br /> � THE CITY 4F GRAND ISLAND, HAL ,_
<br /> � STATE OF'NEBRA9KA—DEPARTMEfVT OF H�AL fH .,
<br /> Buresu o[Vftal St�tlstle�
<br /> CERTIFICATE OF DEATH. -�1�n "•"""""""' . '
<br /> � OATE Of OEAiH ��o�tn. o��,�����
<br /> ' � �•f� SEE -
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<br /> ""' � June
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<br /> • �' , �.," th DATE Of HtTH��o��x. 0••. COUNTY 01 DEA1H � -`.
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<br /> ia Nebraska "°' , -
<br /> �F�� MOTHE�-MAIOlN NIMF -
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<br /> ' IAIMER-NAME ����� 4u L8B If► SuB� � ' �
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<br />= � CERTIHCATION- "o'^" 0�• �0 J ,� - ' }1i ,'!�f M w��t auum HalO -_,
<br /> �M�SICIAN: /- �/ tll � }I� L�`�
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<br /> lt�ll�west Secoud S�. Grand Iel.�und
<br /> MAllINO ADDRESS-CfRi1/1fR C�uite �UG (�n ot�Or� s���� "
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<br /> SU�I�I.CREMAt10N.RFMOVAI J GtMfTE�tOR CtlMATORY-rUME G�'3TSd I.°•1.8T1C� j�E •�
<br />_ "„""� :n Grand Islaaid Cit, ��� /�p/�
<br /> - 7p ��'l'�� �- NAME AND ADO�ESS �I����T a�• �o �O,u��o��owM,fr�n•1'�� I sland�NB• C3V V V-L
<br /> , D�1! �w�w,D��,n��� fUNERPINOM!- U W•KUQjll Grand
<br /> " } ts� Jun� � ��1�5 _ �s� Livin�;atori-Sonderm�u�'s �J ���� nreo u�x�t Rtoisas�
<br /> ...•_er.N�tURE�IiGENSf NO.
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<br />° � WHEN TAIS COPY' CARRIES THE RiTS����IFIES�THE�ABOVEATOABE
<br /> � STATE A.�pARTrI�NT OF�HEALTH,
<br /> A TR[1E CI�PY OE AN ORIGINAI R�CORD ON F ILE WITH THE STAT�
<br /> � DEPARTMENT OF fiEALTTORYU�'ORUV�ITALIRECORDSTISTICS, WHICH .
<br /> IS THE L�GAL DE�OSI �
<br /> - , �)/ (LiQ_ �J�A (
<br /> -. DIItECTOR OF VITAL S'fATISTICS AND A:�SISTANI� STATE R�.GISTRl�R I
<br /> 4
<br /> - LINCOLN, NEARASKA Issucd June l�, 1J7.
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