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<br />89"- 100545
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH. IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DRM7WIT OF HEALTH
<br />BUREAU OF VITAL STATISTICS. WHICH IS THE LEQAL bEFPOl�TORY�` FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />OEC 2 219 7 STANLi*w.S...„ twPXK MMCTOR
<br />LINCOLN, NEBRASKA BUREAU "0!�Yf �TA'TISTICS
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<br />STATE OF NEBRASKA- OEPARTI(IEW & NEALTN
<br />BUREAU OF VITAL STATMT4QS
<br />CERTIFICATE OF 0 EAT�1
<br />DECEDENT - N FIRST Mims six PA E f ". Yt 1
<br />a Frank Tavlor Shull 1_ Male i3•+ccivl3tf .3' 2 _ 19R7
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<br />w101N /QESiCE1tE(•.R.1MIiMMNKM AGE- lw.RwlW
<br />fispet+r, ) (art.)
<br />"DER1 f U 1DA
<br />AA`E@/!tdvAla
<br />MOE DAYS MOORS • µINS.
<br />Jh�
<br />S, American ,, 70
<br />�,,, of ;
<br />r. Sept. 27, 1917
<br />CMTT A TATEOFBIRTH(IFia/<•, .S.A..
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<br />(12
<br />CITIIENOfWHATCOUNTRY""go,
<br />D. NAME OFSFWM6 wift.RiwNi/.wwgw•)
<br />Iowa
<br />U.S.A.
<br />,.
<br />Marie M. Bussinger
<br />BA'rr'spe,
<br />�Paula
<br />SOCIAL SECURITYHOU" R USUAIOCCUP AT ION(GiveNedfd.•rttdoAMd.r:.y.40
<br />RINDOF J 11350!1 STRY COUNTYOFDEAT"
<br />r�,.rL r e. i(rNi )
<br />505 -07 -9367 b"vsti%t Ranager 113b
<br />Fuchs, achinery I c
<br />Adams
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<br />CITT. TOWN OB LOCATION OF DEArI+
<br />INSIDE CITY 1twTL
<br />NOSPITAI OR OTHER INSTITUr10N.-!Nr fit 000 i• �:M• ,
<br />w NOY Ot IHtT w.t•r OoA,
<br />Hastings
<br />IS YNNNI)
<br />*i.•�y••I CAI wba) CMyfit+yhw
<br />P7ary tanning Hospital
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<br />Inpatient
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<br />14'es
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<br />RESIDENCE -STATE COUNTY
<br />CITY, TOWN OR EOCATION
<br />STREET AND NUMBER
<br />INSIDE CITY LUNTS
<br />,,. Nebraska Tom. Hall
<br />Grand Island
<br />172Q S. Spring Rd.
<br />rSP fK+Ear H•)
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<br />A –
<br />HER – MAIDEN NAME FIRST AVOW
<br />Marshal -- Shull
<br />T?- Jessie Leota Baker
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<br />WAS DECEASED EPEE IN Y.S. ARMED FORCES?
<br />«if
<br />INFORMANT - NAME– RELATIONSHIP- MARJNG ADDRESS ($Tull a a10 Cm nn, tth
<br />Is. Yes'~'It �iSw�"� =45 WWI
<br />H. Shull -Wife -1720 S. Spring Rd.-Grand s°Tand,
<br />,Paula
<br />BURIAL. Cre"Ii•If. R.rTd
<br />14, 1987
<br />lApfel-Butler-Geddes
<br />CEMETERY CN CREµ►TORY -NAM[
<br />lOCA1ION CITY OR TOWN STATE
<br />,..Burial
<br />IoDec.
<br />Grand Island Cemetery
<br />Ia Grand Island, Nebraska
<br />Ai a LICENSE NO. 0 FUNERAL HOME -HAMS AND ADDRESS _ ($TNIT 04 R.P 0 NO.. CITY OR TOWN. STATE. tit)
<br />1121W. 2nd, Grand Island, NE. 68801
<br />OF . 051 Ye.) _� DATE SIGN (M,. e,_ .c) "OUR OF O"T"
<br />27� 12"11••87 •a
<br />Ib. 2N µ
<br />ED (Mw, oty. W) INCUR OF DEATH PBOEtOU NCED DEAD PRONOUNCED DEAD (How)
<br />t !y 5-If �. 4:10 a '1 m. fir: s r�_.Orm re.)
<br />v 23Y. 2. ++ 2
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<br />*I— -d Owe ' N• 1• the • Y 0. a10 IwiN6 of ,wirlir w1Nr Memo I wMe. i.�P Mi.ifM It•M NeWIN «
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<br />7SICIAH, COIONIWS P"Y MAN OR C UNm ATL NET) fr,pf qr Xint)
<br />100 Raymond Conant M.D. 2115 ff. Kansas, Hastings Medical Park, Hastings, NE. 68901
<br />!! TRAR
<br />DATE RECEIVED BY REGISTRAR (AM., Der. Yr.)
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<br />2 DEC 221087
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