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n— 1 .gi STATE OF pElRASKA — PEPARTNVM OF WEALTH 200002721
<br />BUREAU OF VITAL ITAT!STIC$
<br />CERTIFICATE OF DEATH
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<br />Mervin Junior Schroeder M
<br />Male F
<br />February 11, 1997 _
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<br />St. Libor Nebraska y
<br />"1016 "°
<br />March 3, 1930
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<br />t 508 30 4880 a —. cF,la
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<br />VA Medical Center, 2201 N. Broadwell D Cc• ❑
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<br />Y 111, T7? M .. OTlln 01 04A1. M r•.10f pF. l..tt
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<br />i Gran3 Island, Nebraska I ... ®. ❑ hall
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<br />7Grand 1
<br />Dr.8801
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<br />Beverly Jean Smith
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<br />» louGFnaw
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<br />_ ltanager_Retired Bowling Centex 1
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<br />Mervin N%M Schroeder (Dec.) Gertrude N
<br />NMN Meinke
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<br />Ir^ +, "eral 1 1l1'•t a+.,r .va... d,R.tA
<br />Ye$ _Lylgtga��6J55- 7i31J71 Beverly Schroeder
<br />•F(1nrLV.t YW.0 AMIYFss ISI-- OF1 R r 11 RO. W1Op lQMilAlE il'1
<br />107 Ce a al rf.ve, Grand island, Nebraska 68801
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<br />[..ice• Feb. 14 IT. Grand and City C�CD1 @CPT
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<br />Livings on- Sonderman T.H. t
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<br />r. r�DKn.I lKW. µ54s (911wFlo,pr� -
<br />601 N. Webb Rd., Grand (sand, Ne. 6880:1- -4050
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<br />s M Cardiopulmonary arrest Minutes
<br />7 to -- I,u[ro. o• >•a.��v ot.Epcl oF F FR....e...w aw....... —'
<br />C0 04 a Congestive Heart Failure 'Years
<br />W,E 10.09 Aa . COR'.EOVERO! OF t
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<br />FOR VITAL STATISTICS USE ONLY
<br />Place._._.... .._......A....._M_.__.__. -8 -._. _._..__.._..__.C..... .__.. ._.0___... _E Part II TMV
<br />NSC._.... ....... _ .............. _._._--....._._._._._.._ .......... ......... ........... _ __.....Census Tract No.
<br />Wcrk....... _ ............ ....---....._...._.._. ....__ ......... ..__............
<br />UC . ................
<br />_.__.._..._......__._....._
<br />Reject_.__._..._........_.
<br />I hereby csl1iry this to be a he and correct copy of the original
<br />hied With the State of Nabraska
<br />Signed in my r-seffefl day o .
<br />Notary Public
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<br />XG10"IRAL
<br />TEARY L LOSCH
<br />My C., e; _s �
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