|
F-
<br />-71 x: {,
<br />7
<br />Original Town W 56' E 60' Lot 7 Blk.-92
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARIMMT OF HEALTH, IT CERTIFIES THE BELOW TO BE A "WIN "COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEFARTlfSKIP: OF Z Ii FI
<br />BUREAU OF VITAL. STATISTICS, WHICH IS THE LEGAL DEPOSiTdi FOR
<br />VITAL RECORDS. - ^Y
<br />&rtv
<br />DATE OF ISSUANCE
<br />APR 1 8 STANLEY S. -*PER, "Mid
<br />•. ,
<br />LINCOLN, NEBRASKA BUREAU OF VITALS ►TI�TICS
<br />89--1.0140 4
<br />STAR OF WORASRA -00AR UM Of NMTN
<br />BUREAU OF IRTAt VAnsms
<br />CERTIFICATE OF DEATH
<br />OE 7147= ' rtSE MIME (AM sex "It OF DEATTI (AI.. D.,. Y. l
<br />Anna Mae e'Ia. zs Female, April ILO, 1988
<br />RAC!- (ft•WfiN. OANt ArriT•n pKitN1DESCENT(, s.h.li••. M•ait.A, AOE -1•M 6MM► UNOlt, At UNL�JESY s LSpjf4/NtTM(MA,pA/, Yi.)
<br />Indira.. ) /SI•tlfl) 0•rr+.•4.1(SI«iE ►1 l7n! MOS DAYS!! M4Yl5:- FiIN. /r :'.
<br />White s American � �/ ,.. 95 � April 4, 1893
<br />CITY AND STATE OitIETNINM /1•USA. CITIZEN O /WHAT COUNTRY MA@IED,NMIIMARMO. 9triA1Wlf0/ SPOU59 fit wh.t.+•..JI.••.•)
<br />.• ••.Ir,l WIpOWEO. DISltxdp) -w --
<br />1"Mayne County, Nebraska 1.0 U.S.A.
<br />SOCIAL SECURITYNUtMEEt USUAIOCCU►AT10"(Gi.• kind • il,"d•Mdoting mo jawo or BUSINESS Oil INDUSTRY C
<br />d ..,.t:•0 rr•. +•.on /x r,Irr•d)
<br />[12 507 -38 -5546 11.11. 17ousew- £is , 13►. rorrestic ,., Hall
<br />(SURIAL ITY, TOWN Of LOCATION OFOVAl , iINSIDECIT7LW13tilQS/ ilAtfi40TNEEMCSTC •,:TJCMC- tl°M(! /sT.w•rMr u�A�D•OfiMf, 1.°.tw00a
<br />.. 1(�p,Ti r•„w'KV..,gn7(� M�,.�fwli,r) �O►7FS+'%"ur[r a. w.,w /I,W/•.
<br />°,, Grand island ;.•.� Yes /,d 1Kf=dgf- -w'aod NTXrsing Home 11.,.:; :inpatient
<br />ESIDENCE -STATE CDu%'P CITY. TOWN O1t000L"CK STREETANDNUMttt cNJIDE CIMIMITS
<br />(--' _Yes N.1
<br />Nebraska Tf hall ,k Grand Island , ;,!w 218 E. Divisil -'a ,�, A N -NAM I MtDOtt MOTH - MAIVLOINAME igs Alr7 LE Andrew Sherman Baker Rebecca Ellen Davis
<br />WAS 0ICEASED EVER IN U S AWED EORCEST INIC)IN ANT- NAME - RELATIONSHIP - MAILING ADDRESS STMET of R I O N0. CIAI OA towN:S.A71. 21.1
<br />o No 1,Xrp. W. M. (Cleo) Woodyard- DauRfiiersl d, lia 68tjjt$j��(�((oj!]1 f Z��6 Apache
<br />Cremation, t•I.w•I pAT .Trt7i : '>! C S CEEMATORT - NAME LOCATION CITT OO TOWN STATE
<br />April 14, 1988
<br />�.. Burial eft ,III . Lase Hill Cemetery god Palter, Nebraska
<br />tt- SIGNATURE • 110N5E NO y3 0 IUNEaAL NOME NAMME AND ADDRESS IfTNETM•10 NO. CITY O. TOWN. STATE. 2111
<br />7 #p£el- Butler- fseddes 1123 W.2nd, Grand Island, NE. 68801
<br />OA (Me.. Dq, if.) UAIII SIGNED (M• O•Y. r..! NOUt 91 DEATH
<br />sM
<br />n.. April 10 1988 =1� 2" -` IA
<br />OA E (M,.. D.E. YI) NOUEt O/ "AI f- 11r • ' r00NOUNCIM VII MONGUNCIMAD!fN°w)
<br />' .
<br />(II Dal. Yr )
<br />mA riI 11 1988 2.0 77tt ift
<br />i • wr w M 4•■•dtA hnr r Iw 4ne AV# prw,. n Sp0 •1.w.:•w..w//r w Wwy.I.I, a .q,p.w. MeN «rwrM r
<br />• [,.,,1.I ••UR u M Rr. A,t• •+d,4.• W d.• r..,•.MM,4rnd
<br />AN AD01! OI CERMil Y . CONON NS NY:ICI 114 1TOENEY) type M Ir1M1
<br />C. D. McGrath M.D. 729 N. Custer., Grand Island, NE. 68803
<br />REGISTRAR , - - - -� DATE KCIM10 tY REGISTRAIR No., Vey, T1.)
<br />]E.u...A,..!!► APZ e 2w. APR 15 1988
<br />A EAU (N FEE on :U E /.1, f L 11,111101.10 AM••.,rf ad 6rs
<br />4 Jed i flex
<br />we 106 ft ACOf/ 1 arl t , nw.•I 6mr •Wa■/fi•r
<br />.
<br />OUE TO, Of WA CON NC1 rrWr �,n,1.•d M�
<br />/AtiT CQ,NWpN7- rM,n tw•IMrO • M,I,M t.,.r rd,IM % N Et IEAIM „A, Wlttw A AYT Y vrA! Mf q AIEEI(1t
<br />» MEOIMNCYM7�/'tli]11QMTNfT ( gt.rN•) RtlA�YAyIllTlOt )
<br />Two N. r
<br />ACCHOW. f11ICM MONCIM iMlt;T. 017E Of •UIr1Y fa,. 0N. T.! NOVf p TIYIr1Y ~� iiiftAiir� C:i'w. OGiiiL :0
<br />O0NI100M0fg10Qwwm (SON *) �..�` - -
<br />► IS& M !M 1Y A, YM - M ft,". . ,.. SOd.
<br />Crt► OO TOW" SWAT/
<br />711.
<br />J
<br />R
<br />p b
<br />r
<br />k.
<br />
|