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1. Doamw WS Nom LOW <br />m M <br />a <br />Frances Burton <br />Female <br />�04wopHelen mber 30, 1993 <br />_ <br />�� <br />Noy" - --- <br />MM Owy, rry <br />° <br />1 <br />rn <br />o <br />ust 2. 1914 <br />ft �.� <br />PLACE OF DATH o..+.. o 9VA,w2w o WA <br />. _ 505-16 -2059 <br />(o dwlEb o RWw o Orpa w <br />'' ��' <br />c° n <br />C:) <br />rn <br />LRII4 Erat Aorbw bL► ,• IaL+A.L.L 1!.a..�. o«nwL.+LJ a ,a NwAE of SPONEE a.+a oti. A.`AU Ar�.l <br />VMDOWM <br />ite American r�b Married Robert H. Burton <br />M <br />p <br />Q. <br />17. MOTTE R • MAIDEN MAW MIST MIDDLE LAST <br />C'D <br />c� <br />o <br />I-A o 'TT <br />p <br />y <br />v <br />Z <br />O <br />XL CR CRHMATOM - NAME <br />no. LOCATION CITY OR TORN STATE <br />rn <br />M <br />D M <br />r -10 <br />C=) <br />Py� <br />2 <br />r. • UGTMTLIIE A UC8W Na AV 30 <br />a Aime L NOME • NAaE AND ADOREaS WFEET OR ".O NO.. CRY OR TOWN. STATE aM <br />fel- Butler - Geddes 1123 W. 2nd, Grand Island, NE 6880: <br />PART. ?ENTER ONLY ONE CNM M LNE FOR ok Nat MID kS: � Ya11ra1 Oaawaan aAwM aNn0 0as1 <br />I <br />AA <br />A t 1aanM1 OaagM OMwI aaa daNM1 <br />I <br />, <br />t <br />I—L n <br />N <br />co- <br />►AMR M i PEMALE WAS THERE A <br />ta. AUTOPSY <br />2'S WAS CASE RKERREO TO MEDICAI <br />I <br />MEONAINCY M THE PAST 2 MOMTHST <br />Hrswb rw ar,Ni <br />EMALINER O11 CORONiETI? <br />CD N <br />DD <br />C <br />/anelJ' Yaw a AW <br />SINCIOE. M10 - <br />OR PENDING NWISTIOATION 408-v <br />ift DA OF MwAM1Y AMa,0a,; nJ <br />2Ae. HOUR OF MWMW 2" DLV418ENOW MLAMIY <br />2K INMRY AT WORN J= <br />. q raa ar fto <br />PLACE OF V LMY - M auaR NYak MGM OM, <br />•w I I I M0. +and" <br />221. NACAl10N MRkET OR R/ O. N0. CITY OR TOWN STATE <br />2h DATE OF DEATH A*-. OW Yy <br />208 DATE SIOHED plea Dv% WJ <br />20. TOM OF DEATH — <br />s <br />trnbr�► '60 \443 <br />a <br />a <br />ZM DATE SMED PW arA nJ <br />27w. TWE OF DEATH <br />WHEN THIS COPYCARR/ES THE RAISED SEAL OF THE NEBRASKA HEALTH ANRCES <br />2aa. PRONDIMwCEp DEAD pbv) <br />` <br />Oe�o ,,� <br />a : �o <br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL <br />141 <br />a <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS <br />21a On dsa Ors q a.aalrNw moor r nefi0a wn. in wT apr"" Gam wwewna at u <br />CawawPN area <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS <br />—_ <br />Gad T. !� <br />yb <br />La Do T011A00O USE ooma m TO 7w <br />70a HAS ORGAN OR TISSUE DONATION SEEN OON GWERED? <br />300, WAS CONSENT ORMNTED? <br />O YES o UNKNOWN <br />DATE OF ISSUANCE <br />200003218 <br />A o YES O No <br />21. NAME AND ADDRESS OF 9=WRR IPHYSICAN, 20ROMMS /HYSICAN OR COUMRY A-,a* Y) IT," ar <br />D. R. soak M. 908 N. Howard, Grand Island, NE. 68803 <br />ML P*GW RAR <br />APR 72000 <br />040 <br />Q � <br />if f n <br />ASS <br />LINCOLN, NEBRASKA HEALTH AND tHAI{" <br />STATE OF Ne@RMA — OQAR MIT OF HMTH <br />@UREA LOF YRAL ST4TWX$ <br />CERT14CATE of DEATH �'_ <br />93-10 A d A <br />1. Doamw WS Nom LOW <br />a 9EX <br />a <br />Frances Burton <br />Female <br />�04wopHelen mber 30, 1993 <br />lb AGE - Lao ?NNW <br />L iar Arkansas '# 19 <br />�� <br />Noy" - --- <br />MM Owy, rry <br />° <br />1 <br />ust 2. 1914 <br />ft �.� <br />PLACE OF DATH o..+.. o 9VA,w2w o WA <br />. _ 505-16 -2059 <br />(o dwlEb o RWw o Orpa w <br />A - of" IA►MnOaft GM 7 &W ftW*" ae CITY. TOWN OR UMTION OF DEATH K MOM CITY LIMLITS M COLMT�06A <br />y ri►Wed3ewood Nursing Center Grand Island Yes <br />• WAT11 _ OL CRY. TOWN OR LOCATION K 571987 AND OWNER plMdlny 20 CaaN 1r X10[ C1TY LIMNf <br />Nebraska kkal Grand 'Island 2011 W. State 68803 Yes�dAa <br />r <br />LRII4 Erat Aorbw bL► ,• IaL+A.L.L 1!.a..�. o«nwL.+LJ a ,a NwAE of SPONEE a.+a oti. A.`AU Ar�.l <br />VMDOWM <br />ite American r�b Married Robert H. Burton <br />Lb, WM— 10.0 ilfdM mat Z wr/q 14o.10NDOSNUSNESSONXXM <br />- MNaaMy ER wrMnSLeE ar �wealawry (612) � <br />Ho ' 91 °'"'� 4 •n•�,., <br />ver 'AA Domestic <br />K FATHER • N1AYE fIMT - IIIDOLE LAST <br />17. MOTTE R • MAIDEN MAW MIST MIDDLE LAST <br />George Washburn <br />Adell Hoffineister <br />HL WAS ONCLOSED IM Q& ARMED FORCES? <br />r a►ASQw RMAO1+wNwerraawacwl <br />19: NPOIMUNT • NME - MAN.NG ADDRESS OTMU OR R F :0. N Q. CITr OR TOWN. NTAjF, jJg,�3 <br />Robert H.- Burton- 2011W. State -Grand Island, NE.- <br />20L. N <br />Xh DATE <br />XL CR CRHMATOM - NAME <br />no. LOCATION CITY OR TORN STATE <br />XSU ial <br />Oct. 4, 1993 <br />Westlawn Memorial Park <br />Grand-Island, Nebraska <br />r. • UGTMTLIIE A UC8W Na AV 30 <br />a Aime L NOME • NAaE AND ADOREaS WFEET OR ".O NO.. CRY OR TOWN. STATE aM <br />fel- Butler - Geddes 1123 W. 2nd, Grand Island, NE 6880: <br />PART. ?ENTER ONLY ONE CNM M LNE FOR ok Nat MID kS: � Ya11ra1 Oaawaan aAwM aNn0 0as1 <br />I <br />AA <br />A t 1aanM1 OaagM OMwI aaa daNM1 <br />I <br />, <br />t <br />lO Ai A OF. t &awvw Oaa.asa "W and dran <br />1 <br />PARTOTIIFJI 1,10MI1CAINT OLYID1T1aNS • fba/Leru mrtANUp b Aa0e W nM nNLwa <br />►AMR M i PEMALE WAS THERE A <br />ta. AUTOPSY <br />2'S WAS CASE RKERREO TO MEDICAI <br />I <br />MEONAINCY M THE PAST 2 MOMTHST <br />Hrswb rw ar,Ni <br />EMALINER O11 CORONiETI? <br />Yw� Q Ir <br />/anelJ' Yaw a AW <br />SINCIOE. M10 - <br />OR PENDING NWISTIOATION 408-v <br />ift DA OF MwAM1Y AMa,0a,; nJ <br />2Ae. HOUR OF MWMW 2" DLV418ENOW MLAMIY <br />2K INMRY AT WORN J= <br />. q raa ar fto <br />PLACE OF V LMY - M auaR NYak MGM OM, <br />•w I I I M0. +and" <br />221. NACAl10N MRkET OR R/ O. N0. CITY OR TOWN STATE <br />2h DATE OF DEATH A*-. OW Yy <br />208 DATE SIOHED plea Dv% WJ <br />20. TOM OF DEATH — <br />s <br />trnbr�► '60 \443 <br />a <br />ZM DATE SMED PW arA nJ <br />27w. TWE OF DEATH <br />WL ►RONOUNM DEAD Aft. ft W) <br />2aa. PRONDIMwCEp DEAD pbv) <br />` <br />Oe�o ,,� <br />a : �o <br />9 <br />a <br />fM "ewaN M srW Gone r taa <br />21a On dsa Ors q a.aalrNw moor r nefi0a wn. in wT apr"" Gam wwewna at u <br />CawawPN area <br />as% a" puce Ina daa b M CA"" owed <br />Gad T. !� <br />yb <br />La Do T011A00O USE ooma m TO 7w <br />70a HAS ORGAN OR TISSUE DONATION SEEN OON GWERED? <br />300, WAS CONSENT ORMNTED? <br />O YES o UNKNOWN <br />V, O YES ADINO <br />A o YES O No <br />21. NAME AND ADDRESS OF 9=WRR IPHYSICAN, 20ROMMS /HYSICAN OR COUMRY A-,a* Y) IT," ar <br />D. R. soak M. 908 N. Howard, Grand Island, NE. 68803 <br />ML P*GW RAR <br />AAM. q�q: TYrJ <br />2L0. DATE NIIED I/Y�/�. <br />040 <br />Q � <br />if f n <br />The West 1/2 of Lots 37 & 38, in West Lawn, in the City of Grand Island, Hall Cty, NE <br />