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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND H_UIM Y! _SERN
<br />SYSTE14 R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISrt�T►'L
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
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<br />MAY 11 2000 T A
<br />ASSI&rA rsT 1
<br />LINCOLN, NEBRASKA HEALTH AND 11 AN SERNI
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<br />STATE OF NEBRASKA — DEPARTMENT OF HEALTH 8 7 04635
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH p_ 4t-()0
<br />M4CIOAW-MAMIN FIRST LA DATE OF DEATH (Me., Day, Yr.)
<br />1. JOHN Joseph- Powell 12. MALE 7 04 -05-87
<br />RACE— (..V.. Wbito, block. A-.ricon ORIGIN /DESCENT(o.V., IM lion, Mos icon, AGE —Ien *_#4•y UNDER 1 YEAR' UNDER 1 DAY DATE OF BIRTH(Mo., Doy, Yr.)
<br />Indion, ofd(SPeciy1 Gorwlen,.TCJ(Specify) (Yn.) MOs. DAYS HOURS. PAINS.
<br />White American n L 74 I
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<br />CITE AND STATE OF BIRTH (11 "1 in U.S.A..
<br />CITIZEN OF WHAT COUNTRY MARRIED, NEVER MARRIED,
<br />NAME Of SPOUSE (If A. Vi,. _id.n —0)
<br />non•o _.") -
<br />Central City, Nebraska
<br />WIDOWED, DIVORCED (Sp.ciry)
<br />19. U.S.A. PTO. Married
<br />Ill. Christina O'Neill
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<br />SOCIAL SECURITY NUMBER
<br />USUAL OCCUPATION (GiTip kind of —li do" di ring ~
<br />KIND Of BUSINESS OR INDUSTRY
<br />COUNTY OF DEATH
<br />PRONOUNCED DEAD
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<br />of k,.g fife, owA if r 6mcf)
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<br />12: 506 -09 -7960
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<br />CITY. TOWN OR LOCATION Of DEATH
<br />INSIDE CITY LIMITS
<br />HOSPITAL OR OTHER INSTITUTION -Me" (N net in oiM•r,
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<br />I NOS/. O[ INST. Indk.t. DOA, /�
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<br />(SP*6fy �Yo, « No)
<br />Vino rtnN o n•wber)
<br />Francis
<br />O.•P•Ii. -I /Mr. R.., 1-P•- (Sp «ify) S
<br />;w, Grand Island
<br />14c. Yes
<br />14d. St. Medical Center
<br />,.�. Emer. Room
<br />RESIDENCE —STATE
<br />COUNTY -
<br />CITY, TOWN OR LOCATION
<br />STREET AND NUMBER
<br />NSIDE CITY LIMITS
<br />1sa. Nebraska
<br />is,,. "all
<br />1k. Grand Island
<br />j'-Sp.rp
<br />1sd. 609 S. Cleburn
<br />Yo• or Ne)
<br />1Se s
<br />Patrick Edward Powell `„ ^`R V' ^^ Mary Anne Heaton
<br />WAS DECEASED EVER IN U.S. ARMED FORCES? INFORMANT— NAME — RELATIONSHIP — MAILING ADDRESS (STREET ON R.F D. NO.. CITY CN TOWN, STATE. ZIP)
<br />IB.No I �,9Christina Powell- Wife -609 S. Cleburn -Grand Is anal NE.
<br />BURIAL, Crete_ tion, Roowval OAT CEMETERY OR CREMATORY —NAME LOCATION CITY OR TOWN STATE
<br />2DR. Burial April 8, 1987 20e Central City Cemetery god. Central City, Nebraska
<br />LME — SIGNATURE i LICENSE NO. ') 6,3 FUNERAL HOME —NAME AND ADDRESS (STM_ET O: 21.0. K0., CITY W TOWN. STATE, ZIP)
<br />1 „Apfel- Butler - Geddes 1123 W. 2nd, Grand Island, NE.68801
<br />The Southerly One Half (S1 /2) of Lot Four (4), in Block Nine (9), Wiebe's Add, Hall Cty, NE
<br />DATEftl DEATH (M... Day. Yr.)
<br />DATE SIGNED (Me. D.P. Yr.)
<br />HOUR OF DEATH
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<br />LOCATION 21111117 OR R.F.D. Ni CITY OR TOWN $1411
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<br />The Southerly One Half (S1 /2) of Lot Four (4), in Block Nine (9), Wiebe's Add, Hall Cty, NE
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