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WHEN 7WIS COPY AMFSTity RAM7 SEAL OF THB NEBRAMA HALM At* hVNi _
<br />SYS7E74 !T CEF'7 F ES ThE BELOW TO BE A TRUE COPY OF THE CVtiGMIAi .. ES..
<br />THE MEBRASP04 H �ALTH AND HUMANSERMCES T�
<br />THE LEPAL DE*&, VCR Y FOR WTAL RECOAn � V7TAL S7AT/Sii%Sa�l�, �{�
<br />p.
<br />DATE OF ISSWNCE pGki'
<br />rr
<br />JUN 15'1109 200005/70 a
<br />LINCOU4 Nf.- ..<SKA WALTHAM
<br />.r.
<br />STATE OF NES3CASXCAv— DEFARTMEW`TOF HEALiA
<br />:' � BurePEr of Y1ta;t SEaiisiir�' (�
<br />GERTIFIGA'��= C�F,,D£A1TH
<br />I�ECEt+E'J -. NAMf _ - . ,sari, '^ V > ...•.� lTau, Ir. Nom.
<br />n otnt Y!
<br />_ - SEX;_ _ DA1f W DEATH I.uN.N, D..,
<br />,. Roi�ert_�.} W 11 zam Graf r.. N. S@ �+, m
<br />RAG v`N1rT, NIG.O AA1f1rCAN r.W .. - Ar • 17 r
<br />!Ak� DAT DATE CM RKiH 1 �pNM oAT
<br />rrc.. �c1t@ i u.MOA(TU!!1 .IcI aw: *wr' C ?tvoG7►, 1
<br />1
<br />rt�f, TOWN. OR IOCA W DEATH, Mu« cm u"m 7it .'P ,
<br />otlNCM,�!a M NO' • NW M i 11t/: OM lrrV .w M+..at 1
<br />2 g /11. Tn .vT Doniphan a =.-no : . +S i• ` , D
<br />.STATt Of ►!RTH 1 u Nor M :fTL2ETt OF WHAT .CQixITRT ACAiR1'J.
<br />R_s1oE._ScI_D,A, ELNSCfE c-u_ c S7r:-MlMlE R w.� ,, wec»o l,lt. %Y/N 1, - .j tDllM . a >G ' , DDM! N .E. v1 ENR O YQ{i
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<br />i�Ii!5 511:111 COn ul
<br />�Bowden
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<br />ndr, e •
<br />On Rebecca
<br />USUAL N O: ► lO DUST pI; KIND 00, APSR1ESS �s T�r'
<br />TA1 8029. a' Fa rII�g u. 50 M
<br />41M N
<br />COUNiT _
<br />_ Cfil, TOWg'LOCAnO. N
<br />Nebr ha . t. e« -
<br />411 n 14 St�tET AN Nu `
<br />R
<br />K
<br />MTHER -NAbIi T r•elt - ..r:+IDDII. +('. ulC MOTMR.�:
<br />• I/ Louis Tri. - , - - -Graf F yNal C wt lAl1
<br />_ MAIDEN NAME f. v
<br />INFORMANT— NAMF— Pf{ATIONSNr}:: .. .. • V@ C. Lenin _.
<br />,
<br />AtA0.PIG ADDRYSi: W xvr, sr.n'aN1
<br />I•'rs. Rebecca 'Graf. wife ,n ; Ural: $oute Dori
<br />ART , phan,rT ie 68832
<br />DEATH WAS CAUSED SY -' FN1ER OFILY
<br />.. • { ONE CAUSE PER LaW fo1. (SL AAD� �tJ{
<br />NfrFN O+SIr .w NAM
<br />Tra zzc Shocl{ immeiate
<br />1pND 110Nl:'1I AN1 �
<br />M c oAra r1s! ro fN electrocution ' immediate
<br />rwwlArr c.vst rar +
<br />llAf O I.a,V Pt. �• O O. A! (.Or+NOVlrK10Ir '
<br />' 111N0 C.Vlt IAlI .
<br />Z"C r.. OTr/N HONA=. CDNDITrONS CONTRIRUtiNO r0 DU ANYW � li07 atATID. - ►An ML r F wAS , ...�.. "A! . AUTO►SY . .161 .rMelNOe
<br />- TO CAYSf us'RM M ►ARf DW ; -'�: j . . t , + taLLf, TtrEt! V TES ctNl.
<br />t1 ,RRaHUICt: w ttli PAST s nDlE+taP : e hS a Nor . w «r!a IN «rra.lNlNO cwvw
<br />... : :_ _ ws G'. NO .o _ : a oe.rr
<br />.ACCID[M: SUK. 6 NOIAICIDf - -1.oNr - M- no , -
<br />o+T, ryAI t MOW INnfRT- OCCVRRID-a 1Mt w VIR DI wlvn IN P•n . tNt rAtf n, rn. 1r r ..
<br />OR11HDt1iRMNfO ryr.o.,r. r - ,:..a _
<br />�' cident r1►.: 9 24 70 >aal 1S' -jc Tw ' contact with wire' -from electric um
<br />t NJV" AT WORK OF MART Ar NdY, IAlAa frRII, rMOtT, _
<br />1l.tun — o. - IOCA/I
<br />owrn f1Dtl., are. a1MCNr'r " : •. ON is'- rsmlr•Ci CJ.D. NG.• cm o(torN,. S.Aq)
<br />es '" �+ '21 mi.` ,South 1.1 miles _++est' of Doni han
<br />Cf'R17iCAT10,1+ rlprrN Mr R.. •11Q1M tiN +tA1 Y9'LAl /L.�11••Iwa,M ON- 1OR /ele 1.DI YIawM DI
<br />►MTErCIAmNN• f1N r .•. , '': TO r - /•O'aM Mt AM OCCVS"*
<br />..... _ .1110, 1 :.. .�a�
<br />n t«R rala -
<br />rir. 11 or .
<br />CtRTMttAtlp►{a.ArfDK'AL r OI. r11. I.! > a IIIR TI• -: 15 K17o MI tiwllry atirw
<br />NA!ll QCL1/!r!0 'bOT --W /o* rw MTIlrr7A r10W M OUM' 1 Mt INCIOM .rA!
<br />rIQN.'fM M. 1tirM1W,
<br />aAAAMIrADON a ,M PARaNOoa TD,r+l1;VvSlfit Sono , . «r - 11-8 lout
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<br />M JUNG AOx S3C'
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<br />Z1 « - .IAn. an
<br />114At,A1, CRLltAT,ON, REMO�rAI T i T N r 1 1 , . 5801
<br />llAn
<br />TI.. Burial ;i +t►: edar (view Cetrie_t_A T+, Doni�han :..die
<br />�A +A - rNOMIM•NI�9M1 PUMERAL H MC w. • �r1 . 1
<br />' ANQ �DfitEi3 Nlttl Wtry.MO ENT.N IO.rM, 1TI/a al•i ..
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<br />Recorder's Memo: The North Half of the Southeast Quarter (NMSEW
<br />of Section Fourteen (14), in Township Nine (9) North, Range Ten
<br />(10), West of the 6th P.M. in Hall County, Nebraska
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<br />WHEN 7WIS COPY AMFSTity RAM7 SEAL OF THB NEBRAMA HALM At* hVNi _
<br />SYS7E74 !T CEF'7 F ES ThE BELOW TO BE A TRUE COPY OF THE CVtiGMIAi .. ES..
<br />THE MEBRASP04 H �ALTH AND HUMANSERMCES T�
<br />THE LEPAL DE*&, VCR Y FOR WTAL RECOAn � V7TAL S7AT/Sii%Sa�l�, �{�
<br />p.
<br />DATE OF ISSWNCE pGki'
<br />rr
<br />JUN 15'1109 200005/70 a
<br />LINCOU4 Nf.- ..<SKA WALTHAM
<br />.r.
<br />STATE OF NES3CASXCAv— DEFARTMEW`TOF HEALiA
<br />:' � BurePEr of Y1ta;t SEaiisiir�' (�
<br />GERTIFIGA'��= C�F,,D£A1TH
<br />I�ECEt+E'J -. NAMf _ - . ,sari, '^ V > ...•.� lTau, Ir. Nom.
<br />n otnt Y!
<br />_ - SEX;_ _ DA1f W DEATH I.uN.N, D..,
<br />,. Roi�ert_�.} W 11 zam Graf r.. N. S@ �+, m
<br />RAG v`N1rT, NIG.O AA1f1rCAN r.W .. - Ar • 17 r
<br />!Ak� DAT DATE CM RKiH 1 �pNM oAT
<br />rrc.. �c1t@ i u.MOA(TU!!1 .IcI aw: *wr' C ?tvoG7►, 1
<br />1
<br />rt�f, TOWN. OR IOCA W DEATH, Mu« cm u"m 7it .'P ,
<br />otlNCM,�!a M NO' • NW M i 11t/: OM lrrV .w M+..at 1
<br />2 g /11. Tn .vT Doniphan a =.-no : . +S i• ` , D
<br />.STATt Of ►!RTH 1 u Nor M :fTL2ETt OF WHAT .CQixITRT ACAiR1'J.
<br />R_s1oE._ScI_D,A, ELNSCfE c-u_ c S7r:-MlMlE R w.� ,, wec»o l,lt. %Y/N 1, - .j tDllM . a >G ' , DDM! N .E. v1 ENR O YQ{i
<br />Is
<br />l.grN i
<br />i�Ii!5 511:111 COn ul
<br />�Bowden
<br />trl_ er w .
<br />v,
<br />ndr, e •
<br />On Rebecca
<br />USUAL N O: ► lO DUST pI; KIND 00, APSR1ESS �s T�r'
<br />TA1 8029. a' Fa rII�g u. 50 M
<br />41M N
<br />COUNiT _
<br />_ Cfil, TOWg'LOCAnO. N
<br />Nebr ha . t. e« -
<br />411 n 14 St�tET AN Nu `
<br />R
<br />K
<br />MTHER -NAbIi T r•elt - ..r:+IDDII. +('. ulC MOTMR.�:
<br />• I/ Louis Tri. - , - - -Graf F yNal C wt lAl1
<br />_ MAIDEN NAME f. v
<br />INFORMANT— NAMF— Pf{ATIONSNr}:: .. .. • V@ C. Lenin _.
<br />,
<br />AtA0.PIG ADDRYSi: W xvr, sr.n'aN1
<br />I•'rs. Rebecca 'Graf. wife ,n ; Ural: $oute Dori
<br />ART , phan,rT ie 68832
<br />DEATH WAS CAUSED SY -' FN1ER OFILY
<br />.. • { ONE CAUSE PER LaW fo1. (SL AAD� �tJ{
<br />NfrFN O+SIr .w NAM
<br />Tra zzc Shocl{ immeiate
<br />1pND 110Nl:'1I AN1 �
<br />M c oAra r1s! ro fN electrocution ' immediate
<br />rwwlArr c.vst rar +
<br />llAf O I.a,V Pt. �• O O. A! (.Or+NOVlrK10Ir '
<br />' 111N0 C.Vlt IAlI .
<br />Z"C r.. OTr/N HONA=. CDNDITrONS CONTRIRUtiNO r0 DU ANYW � li07 atATID. - ►An ML r F wAS , ...�.. "A! . AUTO►SY . .161 .rMelNOe
<br />- TO CAYSf us'RM M ►ARf DW ; -'�: j . . t , + taLLf, TtrEt! V TES ctNl.
<br />t1 ,RRaHUICt: w ttli PAST s nDlE+taP : e hS a Nor . w «r!a IN «rra.lNlNO cwvw
<br />... : :_ _ ws G'. NO .o _ : a oe.rr
<br />.ACCID[M: SUK. 6 NOIAICIDf - -1.oNr - M- no , -
<br />o+T, ryAI t MOW INnfRT- OCCVRRID-a 1Mt w VIR DI wlvn IN P•n . tNt rAtf n, rn. 1r r ..
<br />OR11HDt1iRMNfO ryr.o.,r. r - ,:..a _
<br />�' cident r1►.: 9 24 70 >aal 1S' -jc Tw ' contact with wire' -from electric um
<br />t NJV" AT WORK OF MART Ar NdY, IAlAa frRII, rMOtT, _
<br />1l.tun — o. - IOCA/I
<br />owrn f1Dtl., are. a1MCNr'r " : •. ON is'- rsmlr•Ci CJ.D. NG.• cm o(torN,. S.Aq)
<br />es '" �+ '21 mi.` ,South 1.1 miles _++est' of Doni han
<br />Cf'R17iCAT10,1+ rlprrN Mr R.. •11Q1M tiN +tA1 Y9'LAl /L.�11••Iwa,M ON- 1OR /ele 1.DI YIawM DI
<br />►MTErCIAmNN• f1N r .•. , '': TO r - /•O'aM Mt AM OCCVS"*
<br />..... _ .1110, 1 :.. .�a�
<br />n t«R rala -
<br />rir. 11 or .
<br />CtRTMttAtlp►{a.ArfDK'AL r OI. r11. I.! > a IIIR TI• -: 15 K17o MI tiwllry atirw
<br />NA!ll QCL1/!r!0 'bOT --W /o* rw MTIlrr7A r10W M OUM' 1 Mt INCIOM .rA!
<br />rIQN.'fM M. 1tirM1W,
<br />aAAAMIrADON a ,M PARaNOoa TD,r+l1;VvSlfit Sono , . «r - 11-8 lout
<br />ttrtrLU— rnN M wA.p A .
<br />.... r tS
<br />� .0
<br />M JUNG AOx S3C'
<br />. f
<br />0
<br />/.rWI 1
<br />Z1 « - .IAn. an
<br />114At,A1, CRLltAT,ON, REMO�rAI T i T N r 1 1 , . 5801
<br />llAn
<br />TI.. Burial ;i +t►: edar (view Cetrie_t_A T+, Doni�han :..die
<br />�A +A - rNOMIM•NI�9M1 PUMERAL H MC w. • �r1 . 1
<br />' ANQ �DfitEi3 Nlttl Wtry.MO ENT.N IO.rM, 1TI/a al•i ..
<br />f(0
<br />TO A t f �f A 8 t '
<br />d
<br />Recorder's Memo: The North Half of the Southeast Quarter (NMSEW
<br />of Section Fourteen (14), in Township Nine (9) North, Range Ten
<br />(10), West of the 6th P.M. in Hall County, Nebraska
<br />LTe
<br />
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