|
I
<br />$9-- 100414
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA ST47S
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE CQPY.
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEP031TORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE'
<br />.IAN S 4 IM STANLEY S. COOPPA► DjRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />STATE W KWMKA -WAMUM OF II au
<br />AI M OF IMTAL STATISTICS
<br />CERTIFICATE OF DEATK r
<br />"OLJR p 1wYtf ORRCMRQ N•J1.I )W YRT OCCUYlO
<br />' a nMRReo 0M$ttDA1T0e" rrr«.ay�
<br />Tor. 70e M 70I.
<br />' I1e)Ufl AT WORK – Y "ene "�
<br />) 1
<br />PIACIF OF 7
<br />Mutw ..I.eee -". L
<br />LOCATION $
<br />$tslTCla Lf a Ne CLTf ORrOoN StATE
<br />(free y Yw w "a) e
<br />eNNe lt.rit/iM. er ($Pwdrl
<br />70th. 7
<br />701. 7
<br />702
<br />) 1
<br />PIACIF OF 7
<br />N -NAME R pA DEATH A1M.. Da,. T..)
<br />Bufford Floyd Tyson Male December 25, 1988
<br />SA E –Ow. wum. 11111416 AAw7eM ORIOMIINSCINI(e.q.,N11 ier..M,"i"�II, AO! –LrR M► U 1 Af U R 1 OwY QATlOFBIRTN(AI,.,DrY,T..)
<br />4"+•( �`".american V (Ya.)b8 Aq ' ' OA NOUn. ' April 20, 1920
<br />J A .1 M / "N i.Y.S.A., CI EENq WHATC NTIn N MARK D. NAVA OFSPOUSE(M- .BMMiI" ".NNM)
<br />vn ED. !ofs"";,)
<br />ifiiti'urn, Nebraska 19. U.S.A. to. °arr°�°e� III Grace Ducker
<br />SOCLALSECURITYNUMB R YSYAIOCytW�,ATION(�Giw/li"/d"Ado" do:e@aw jK*40OF GUSIMUOR INDUST" CCNINTTCMDIATN
<br />17 506 -16 -8938 4010" 44/0
<br />J)r 6r �� 13b 140.
<br />,M Hall
<br />Cm, TOWN OR LOCATION 010EATN INSIO! CITY LIMITS NOS►ITAL OTHER INSTITUTION -Name (N ""I iA,iM.. slow Do tNp. A."i.Me Roe►
<br />Grand Island 'u- i'Pse "' "VQ- 'ffancis Medical Center , Inpatient
<br />BESIDlHCE -STATE COUNTY Icily. TDwN OR LOCATION 13TREET AM NUMBER INSIDE! CITE UMITS
<br />Nebraska ISY Hall ,st Grand Island t� 222 N. Grace ;� ` N"'
<br />A - H -AML N HAW FIRST AVME— LAST
<br />I Floyd Edward Tyson Ethel May Holmes 17,
<br />WAS DECEASED EPEE IN U.S. ARMED roicnT INEOMUMT- HAMIF- REIADONSHIP- A"NLINO AM"&% .Ivjwdt a A e a
<br />�i ..g,� +If(M.« ,6..... «.M.I....�.) t� Grace Tyson -Wife -222 N. Grace -Grand Island, NE. 68801
<br />114.011 Ge"I"Ti" R"AI"wl 49MVERT OR CREMATORY - NAME LOCATION CITT OR TOWN STAID
<br />70. Burial Ta.eC• 29, 1988 zo" Westlawn Memorial Park 2 Grand Island, NE.
<br />R- ATURE L ENSE NO. FUNERAL NOME -NAME AND ADDRESS ($Valli M E f -a No.. cery on TOWN. STALL TNt
<br />,,Apfel- Butler - Geddes 1123 W. 2nd, Grand Island, NE. 688,
<br />OF D"T" (Ala.. 0111 Tr.) A N (M,. ,, Tr.) R OF DEATH
<br />_,.. December 25, 1988 kg ,,,. ;1e
<br />(M*-. per. yr.) TFE - • PRONOUNCED , "ONOUNCED DEAD X.r) M
<br />77r.. December 30 1 ii (AM.. Dep. W.) 4.
<br />77T. l :1 F M r 2
<br />Z e"w.e�ilel etel%M' I".•tMN b.M ne "ewe. M w .Ae ....+.IL. : u
<br />�"+IR+w. .�rf e"teteA Mw e[IwnN eA
<br />$ M oLer.I"I. W 11we ""/ A:e • a u.+W .TA/IL
<br />,( -9-6 e"1 G"er� 2"s.,Zlle"..n sad tare), .
<br />HAM AND APPRIES3 OF VIEWSPRE qM t MN COUNtY AiTORNEYI g !� N ►aM)
<br />David R. Golan, M.D. 729 N. Custer, Grand Island, Imo. 68803
<br />OIS - DATE EIY D BY REGISTRAR (Me.. Dap Yr.)
<br />E...( ..I..N� - , JAN 3 1989
<br />A U E (ENTER Y ONE CAUSE • / IN FOR (A), (A). AND (T)) 1elee.el M►.ee" ewM.M Iwlu
<br />F 3�it�S
<br />DUN To. Oil AS A CON ENC[ Or: , t"ww, ber wea err a.W deed,
<br /><w
<br />DUE TO. OR AS A CONSEQUENCE o/: ! I"lenwl ►et...e. ewer wM Nat.
<br />:d
<br />PART N"#R. IC -01"T COAaI1N0N$– ee"Melw, w death W w.elAed PART OL It AE.I"IR. WAS THIN A AuTOrSf A$ CA"" 01""O TOMEDIIAL
<br />If MIONANCY IN THE PAS 2MONTH$! (LAes:fr lie. e. may AYM)IR OR CMDefN
<br />yes(] �_ oc r fw er MY
<br />120 125 .
<br />ACCINMa. ItIKK)!. 101. OAtI Of f (Ma. Der. 11r.)
<br />V
<br />c
<br />r•
<br />F+ '
<br />Mutw ..I.eee -". L
<br />LOCATION $
<br />$tslTCla Lf a Ne CLTf ORrOoN StATE
<br />(free y Yw w "a) e
<br />eNNe lt.rit/iM. er ($Pwdrl
<br />70th. 7
<br />701. 7
<br />702
<br />V
<br />c
<br />r•
<br />F+ '
<br />
|