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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRA_SRA STATE
<br />.DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TWE' COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPA1tTkM OF HEALTH
<br />VITAL UROF VITAL STATISTICS, WHICH IS THE LEGAL. DEPOSITORT FOR 89-;--;101592
<br />DATE OF ISSUANCE `A
<br />FEB 7 1989 STA tIEY S: C00PLj;' DIRECTOR
<br />LINCOLN, NEBRASKA BUREW-,.oF VITAL STATISTICS
<br />STATE HEALTH
<br />9UNE4U OF VItAI STAI�-77II''S
<br />CERTIFICATE OF KITH
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<br />DATE Of DFA_IH (Ale., Day, Fr.)
<br />T Harold Dale D O's
<br />Male
<br />January 26, T3��:. •. ..
<br />R!►GE� w.� tiN. loci, AeN, teeONGINfDEKENT
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<br />CSeraew, etc 1(SVeciiFl (t".1
<br />UNDER L YEAI UNDE IDAY - (fL EOltIRIN1Afr.,Op /,TcJ
<br />MOS. DAYS NODES . MINS:. -. �„
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<br />Americana d 45
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<br />eb a. * .:1u a 19 3
<br />IPVT AND STATE Of BIRTH ( not a US A,
<br />CITIZEN CN" id4 ":OUNTtYMARRIED,NEVERIAROID, NAME OF5114MM•KNai /w,0igaaeHaease)
<br />Avon reuAtry)
<br />R. Rockville, Nebraska
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<br />it U413 A . , °' iti. Married I„ Patncgza Cunnift ham
<br />SOCIAL SECUBWHEMMER
<br />USUAL OCCUPATION ( b._ i),•.erl4litew.dkortipme"
<br />AINDOftUSINESSCRINDUSTRY
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<br />: .DEATH
<br />506 -50 -13
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<br />113, Care
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<br />CITY. TOWN OR LOCATION OfCEAT14
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<br />Grand Island
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<br />'Irtancis Medical Center
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<br />vs.. Nebraska
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<br />HER- MAIDENNAMt FIRST MIME LAST
<br />1_ Edward -- Deeds
<br />117, Marie -- Edghill
<br />WAS DECEASED EVER IN U S ARMED FORCES?
<br />INTORMANT- NAME- RELATIONSN /►-MAILING ADDRESS MatEt Ce t r D NO CIF' at LOW ".'jiboot
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<br />I #Patricia Deeds- wife -2804 Kitt ston Circle Grand Is and,
<br />RUMAL, Ctemokso, Reetewl •
<br />CCA41TIOV OR CREMATORY -NAMI
<br />LOCATION CITI OR TOWN STATE
<br />Zoe. Burial rob Jan. 28,__1989
<br />eat Westlawn Memorial Park
<br />2Jd Gra13.it' Island Nebraska
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<br />27 Livi�stcn�Sondermann 505 W. Koenig_ Grand I►�•irtrZd88NE
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