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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AW JWMAN SERVICES
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE O�L_'RE40M ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, WTA"M flail E£T/EtN, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DA(T�EO1F ISSUANCE
<br />LINCOLN, NEBRASKA
<br />-N77n, •AYwrt�,pAYlpf►AIeMa+M�eiAali" c ray _ .�
<br />• Box Lanning =Memorial Hospital � `
<br />OR LOLAIC%OF OSATM .. M -a78DE CfTF UMYS..
<br />Hastings is C
<br />-STATE fb COMITY ft CITY TOM OREOCA, _
<br />Nebraska . Hall Grand,-, Ia
<br />a alD, awk NIWWW MNI 11 ANMTRY M 9 ft%M &*9&V G@n1W : V C3 1 '
<br />HEALTH AND HUMAN SERVICES SYSTEM
<br />µ t V
<br />Eltf 1DP NRALTIf a # a
<br />39,".5 0 6 6.6 3
<br />vT
<br />ar r z, sFx s DATE cF DEAT7r na,AFA tan
<br />M° Male ; June 2,`,'1995'
<br />!!F tINBER f pAY a OA TETJF BMTN OMr rAMn,
<br />June 30 IJ43.
<br />�'�'�"WWM• �'NugAgyArr
<br />]` r OrMV`AFa : AurMnDM
<br />F town oe uEwT>, �--•`
<br />Adams
<br />C4 . AND NUMEEA rAitAiabO • - . M. MtS10E C_ L-W
<br />721 N. Superior St 68402f Ya E] ,. 0
<br />Uw�Or1EO ty 7«aME OF rraa.a.ee�
<br />+r, to American .s," ; ,"''" D7rDRCE'R Mary Vasquez
<br />LL.
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<br />IA1lg1.NWE FfRST WIOME LAS 1# YDTNER. FPST ..
<br />tA00L[ > taWDlwafMwAAE
<br />;Richard E. . Williams Jane A. Gajus
<br />la 9 PMAMD EVER N U6 Navy: 4 27 b2 'a• •soRwwt.wwE
<br />MfaAT►a/� lawf .W�faafiaa
<br />X8S 7/25WVO!A my:l 3/91 -7/119 Mar Llfzabeth Williams
<br />App", '.r BEET OR F,D NO, CITY OR TOWN SM
<br />� 1 N. Super pr.Stre)et, Grand Island, ,Nib raska.68801
<br />` (( 9l ?t► AETOMOFdSF6lITf1M •2% OATS ?T6 C YETERI OR WE4►jG4ri fMME
<br />AOO ®B ❑IA,A�DY, June 6, 1995 Grand Island City Cemetery_
<br />21., NAME V NO CEAETETW OR CREMATORY LOCAjx* -: pfr CYt TOWN -- iTAff
<br />Livingston- Sondermann F.H. ❑ 0 Grand Island, Nebraska
<br />fhMfE'RAL NOW AWRISS ISTREETORAFIIND CITY.ORTONN STATE. Z", - - --
<br />505 West Koenig, Grand Island, Nebraska'68801
<br />ii: aMEdATE CAD�SE/� fEhpTER ORLr ONE P,AtI$E vEA tM1E FOR,tAt. Ipr, ANDtcu.YiyralpwYwn•rget
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<br />160W TO.OR AS A COfaTEOUENCE OF - ,ee'YrMtrAwen orwM Ane D.M
<br />DUE TO OR AS A CONSEOAP" OF
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<br />ME.GNANCY IN THE PAS? 3 MOMT115r --r ft OR CORUNFw'
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<br />>d ]® DATE OF AT,A/RY :Ab UA. YJJ 2ac.: NOfMtOF IN�AIR'I _ +' OESCTYBE HOW OwRv oCCURRE0
<br />❑ SatOe ❑ PT +rYJ 2% /7.AJAY AT WOFIIt 2MF VkK 4t,RJtRY./1f 1�q�.N)m}•.pa!!f pt7ary 2ft fpCAT10N STREET OR RFO NO Ca Y OR j&" SIAiE '
<br />❑ H..Wr wYesgrwr VAM do..Y.1 -
<br />' TA DATE Of MAT- ,11D Gw .rrl; - 2fff PATE SIGNED tW Oxv VII - 2M0 14E0F OEATIt –v
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<br />ETb DATE STONED Mo DAr I.t , 27C
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<br />129 OD Yp6ACC0115E TE bEAtH= 7aI WAS ORGAN OR TtWX DDNAT*N BEEN CONSIDERED+ 70D WAS CONSEMGRANTfD*
<br />YES tMafN 1L. YES. � El NO. .. X � � -..O NO
<br />V WAIK AND AOORE'SSOF RSROSICNNORCOMYTTATTORNEYI tTAWSIPI.V
<br />A REGISTRAR 32b DATE FLED BY REGISTRAR OW 0., y,l
<br />JUN 141M
<br />Lot Four (4), in Block Two (2), in John W. Lambert's Addition to the City
<br />of Grand Island, in Hall County, Nebraska.
<br />200104272
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<br />HEALTH AND HUMAN SERVICES SYSTEM
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<br />Eltf 1DP NRALTIf a # a
<br />39,".5 0 6 6.6 3
<br />vT
<br />ar r z, sFx s DATE cF DEAT7r na,AFA tan
<br />M° Male ; June 2,`,'1995'
<br />!!F tINBER f pAY a OA TETJF BMTN OMr rAMn,
<br />June 30 IJ43.
<br />�'�'�"WWM• �'NugAgyArr
<br />]` r OrMV`AFa : AurMnDM
<br />F town oe uEwT>, �--•`
<br />Adams
<br />C4 . AND NUMEEA rAitAiabO • - . M. MtS10E C_ L-W
<br />721 N. Superior St 68402f Ya E] ,. 0
<br />Uw�Or1EO ty 7«aME OF rraa.a.ee�
<br />+r, to American .s," ; ,"''" D7rDRCE'R Mary Vasquez
<br />LL.
<br />fU07YiT� w'M JAY�/tlI e
<br />Buildin M T t. Su er vis or V.A. ..., H.. os ital d (y 3 ( I e+w�+sw► v s.u.�w la =a► C�u•4 • _ ,> . .s.:.`. .
<br />IA1lg1.NWE FfRST WIOME LAS 1# YDTNER. FPST ..
<br />tA00L[ > taWDlwafMwAAE
<br />;Richard E. . Williams Jane A. Gajus
<br />la 9 PMAMD EVER N U6 Navy: 4 27 b2 'a• •soRwwt.wwE
<br />MfaAT►a/� lawf .W�faafiaa
<br />X8S 7/25WVO!A my:l 3/91 -7/119 Mar Llfzabeth Williams
<br />App", '.r BEET OR F,D NO, CITY OR TOWN SM
<br />� 1 N. Super pr.Stre)et, Grand Island, ,Nib raska.68801
<br />` (( 9l ?t► AETOMOFdSF6lITf1M •2% OATS ?T6 C YETERI OR WE4►jG4ri fMME
<br />AOO ®B ❑IA,A�DY, June 6, 1995 Grand Island City Cemetery_
<br />21., NAME V NO CEAETETW OR CREMATORY LOCAjx* -: pfr CYt TOWN -- iTAff
<br />Livingston- Sondermann F.H. ❑ 0 Grand Island, Nebraska
<br />fhMfE'RAL NOW AWRISS ISTREETORAFIIND CITY.ORTONN STATE. Z", - - --
<br />505 West Koenig, Grand Island, Nebraska'68801
<br />ii: aMEdATE CAD�SE/� fEhpTER ORLr ONE P,AtI$E vEA tM1E FOR,tAt. Ipr, ANDtcu.YiyralpwYwn•rget
<br />f /
<br />160W TO.OR AS A COfaTEOUENCE OF - ,ee'YrMtrAwen orwM Ane D.M
<br />DUE TO OR AS A CONSEOAP" OF
<br />Wi
<br />NER. SKVMCANiW4 7KJ�a.•CdrOMUr�cp4ipr4 b.MA.11A to oat MW". -.pARI JII Ii FE1AlIti WAS FMEREA N MOMS' ,2S: WASCAfE""ERREJ TO w ack
<br />ME.GNANCY IN THE PAS? 3 MOMT115r --r ft OR CORUNFw'
<br />.Apic t054 .. Yfs t 1 N* n Y""
<br />es
<br />�. __�__.- -.
<br />>d ]® DATE OF AT,A/RY :Ab UA. YJJ 2ac.: NOfMtOF IN�AIR'I _ +' OESCTYBE HOW OwRv oCCURRE0
<br />❑ SatOe ❑ PT +rYJ 2% /7.AJAY AT WOFIIt 2MF VkK 4t,RJtRY./1f 1�q�.N)m}•.pa!!f pt7ary 2ft fpCAT10N STREET OR RFO NO Ca Y OR j&" SIAiE '
<br />❑ H..Wr wYesgrwr VAM do..Y.1 -
<br />' TA DATE Of MAT- ,11D Gw .rrl; - 2fff PATE SIGNED tW Oxv VII - 2M0 14E0F OEATIt –v
<br />1
<br />ETb DATE STONED Mo DAr I.t , 27C
<br />2BPRONOIM/00EA0 /AA DK ri/ aa ~
<br />/RDWOOM'ID DEAD' /flpu.r
<br />3 T To MraWd4' DY► nr ar. a71ie P tae O. ns aw of aA.ro..&-o a, m o wna*Wa ~Dawn*avowr
<br />tarl,i f171ea a= » Mre Ww 0" Ally pbee A.a Due b ale C&J.014 go"
<br />aM. T4 ar4 Tr„
<br />129 OD Yp6ACC0115E TE bEAtH= 7aI WAS ORGAN OR TtWX DDNAT*N BEEN CONSIDERED+ 70D WAS CONSEMGRANTfD*
<br />YES tMafN 1L. YES. � El NO. .. X � � -..O NO
<br />V WAIK AND AOORE'SSOF RSROSICNNORCOMYTTATTORNEYI tTAWSIPI.V
<br />A REGISTRAR 32b DATE FLED BY REGISTRAR OW 0., y,l
<br />JUN 141M
<br />Lot Four (4), in Block Two (2), in John W. Lambert's Addition to the City
<br />of Grand Island, in Hall County, Nebraska.
<br />Uw�Or1EO ty 7«aME OF rraa.a.ee�
<br />+r, to American .s," ; ,"''" D7rDRCE'R Mary Vasquez
<br />LL.
<br />fU07YiT� w'M JAY�/tlI e
<br />Buildin M T t. Su er vis or V.A. ..., H.. os ital d (y 3 ( I e+w�+sw► v s.u.�w la =a► C�u•4 • _ ,> . .s.:.`. .
<br />IA1lg1.NWE FfRST WIOME LAS 1# YDTNER. FPST ..
<br />tA00L[ > taWDlwafMwAAE
<br />;Richard E. . Williams Jane A. Gajus
<br />la 9 PMAMD EVER N U6 Navy: 4 27 b2 'a• •soRwwt.wwE
<br />MfaAT►a/� lawf .W�faafiaa
<br />X8S 7/25WVO!A my:l 3/91 -7/119 Mar Llfzabeth Williams
<br />App", '.r BEET OR F,D NO, CITY OR TOWN SM
<br />� 1 N. Super pr.Stre)et, Grand Island, ,Nib raska.68801
<br />` (( 9l ?t► AETOMOFdSF6lITf1M •2% OATS ?T6 C YETERI OR WE4►jG4ri fMME
<br />AOO ®B ❑IA,A�DY, June 6, 1995 Grand Island City Cemetery_
<br />21., NAME V NO CEAETETW OR CREMATORY LOCAjx* -: pfr CYt TOWN -- iTAff
<br />Livingston- Sondermann F.H. ❑ 0 Grand Island, Nebraska
<br />fhMfE'RAL NOW AWRISS ISTREETORAFIIND CITY.ORTONN STATE. Z", - - --
<br />505 West Koenig, Grand Island, Nebraska'68801
<br />ii: aMEdATE CAD�SE/� fEhpTER ORLr ONE P,AtI$E vEA tM1E FOR,tAt. Ipr, ANDtcu.YiyralpwYwn•rget
<br />f /
<br />160W TO.OR AS A COfaTEOUENCE OF - ,ee'YrMtrAwen orwM Ane D.M
<br />DUE TO OR AS A CONSEOAP" OF
<br />Wi
<br />NER. SKVMCANiW4 7KJ�a.•CdrOMUr�cp4ipr4 b.MA.11A to oat MW". -.pARI JII Ii FE1AlIti WAS FMEREA N MOMS' ,2S: WASCAfE""ERREJ TO w ack
<br />ME.GNANCY IN THE PAS? 3 MOMT115r --r ft OR CORUNFw'
<br />.Apic t054 .. Yfs t 1 N* n Y""
<br />es
<br />�. __�__.- -.
<br />>d ]® DATE OF AT,A/RY :Ab UA. YJJ 2ac.: NOfMtOF IN�AIR'I _ +' OESCTYBE HOW OwRv oCCURRE0
<br />❑ SatOe ❑ PT +rYJ 2% /7.AJAY AT WOFIIt 2MF VkK 4t,RJtRY./1f 1�q�.N)m}•.pa!!f pt7ary 2ft fpCAT10N STREET OR RFO NO Ca Y OR j&" SIAiE '
<br />❑ H..Wr wYesgrwr VAM do..Y.1 -
<br />' TA DATE Of MAT- ,11D Gw .rrl; - 2fff PATE SIGNED tW Oxv VII - 2M0 14E0F OEATIt –v
<br />1
<br />ETb DATE STONED Mo DAr I.t , 27C
<br />2BPRONOIM/00EA0 /AA DK ri/ aa ~
<br />/RDWOOM'ID DEAD' /flpu.r
<br />3 T To MraWd4' DY► nr ar. a71ie P tae O. ns aw of aA.ro..&-o a, m o wna*Wa ~Dawn*avowr
<br />tarl,i f171ea a= » Mre Ww 0" Ally pbee A.a Due b ale C&J.014 go"
<br />aM. T4 ar4 Tr„
<br />129 OD Yp6ACC0115E TE bEAtH= 7aI WAS ORGAN OR TtWX DDNAT*N BEEN CONSIDERED+ 70D WAS CONSEMGRANTfD*
<br />YES tMafN 1L. YES. � El NO. .. X � � -..O NO
<br />V WAIK AND AOORE'SSOF RSROSICNNORCOMYTTATTORNEYI tTAWSIPI.V
<br />A REGISTRAR 32b DATE FLED BY REGISTRAR OW 0., y,l
<br />JUN 141M
<br />Lot Four (4), in Block Two (2), in John W. Lambert's Addition to the City
<br />of Grand Island, in Hall County, Nebraska.
<br />
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