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<br />9
<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 DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JAN 10 X989
<br />LINCOLN, NEBRASKA
<br />At&
<br />41 &?Sb
<br />STANLEY S. COOPER, DIRECTOR
<br />BUREAU OF VITAL'STATISTICS
<br />89-101634
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<br />Il. ! JRTS- (City. wwn or matt) (state I!. C1T1LleN OF %a&T'
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<br />M FATIIIIAS HAUB
<br />Its. MOTHIINll UMDZN HAUB
<br />IIw HAUB OF MUSSA 40 OR WIFE
<br />li, wits DILC><ASxb Ltd IN U. & ARUZD FORCES? ti. SOCIAL SeCURITT 11. IN RALLNTS NANE or sisaatara A Addrew , )y
<br />(Y•r, me. K oaha•w11) 11t 1016 elro was w char od a 11" NO.
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<br />IL CAUSX Uf 11"111 D'NMI 'Am- CEtirlylt)ATION Isurval n,twrrw
<br />L1•r only owo r•"•a ••r rOND1TiON Oa'•/ aed wrath
<br />i. DIdEASL OR
<br />Ila• for (a1. /h1, awl (•) DjRZOTLY LZADINO TO DZATH•
<br />•Tit• dam, aN moan dw ANTZCSDRNT CAUSES
<br />DUE TO 11)/.
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<br />/aMoe•. a■Ihooh. was" emausem It say. flrtae
<br />• it boom The d "" t• 4* abbe raw (a) otatlq
<br />•w. Iajtanl.*rem $be mrAwty`iae taw Ott. DUE TO (,) ....... . ......
<br />IIM whiffs laarrd _ _.._..........
<br />?; it. OTHER =NIFICANT CONDITIONS
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<br />• roiatoi N Iha d{aew ae'rw.1111Mw roast dNli.
<br />Ifr aC'.E OF OF
<br />;W MAJO•JR'YUVUINOS OF ORATION• (!d. AUTOPSYI
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<br />Ste. ACI Z11ST (Sprit!) Jk• PLACS OF INJURY Ir.a., in or shoot
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<br />Ste. CITY OR TOWN) (COUNTT)` (SfATS)
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<br />tt.r Bertrily oeretty rMlt eteeluJJ�t fife deeersa«I Jraln��t�, to........: ....... ....... , 1l......., that I kmf saw the de-
<br />M',ried J�i,.nt.,
<br />Oeaeed alive on.. ..,19.. .., Gild that death at .,t�. from the cawee and olt the dots elated above.
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<br />i/a, NURIAI. h` VATR fro NAlfi OF C92=xny
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<br />OR Idd. LOCATI ( .taws. or autl Sato)
<br />?ION. AL t
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<br />VATIR FAWD my 110113271RARS 04
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<br />L a•„n unwwemw ...w
<br />•.... •.v.aa�u�•ra %4unmawm %"VrG/ VC JGR+lIV" WIWI,. k7), RuwNbI11Y IUW t IU)
<br />NORTH, RANGE ELEVEN (1 1) WEST OF THE 6TH P . F.'.. , HALL COUNTY',
<br />NEBRASKA, EXCEPTING A TRACT MOVE PARTICULARLY DESCRIBED A.S. F01,LOWS:
<br />OEGINNING AT THE SOUTHEAST COO JER OF SAID 1:G1THEASIT QUARTER (NE0
<br />OF SECTION NINE (9), 'HENCE NR)R,TH ALONG, THE :,-AST Liar• o,,, `SAID
<br />NORTHEAST QUARTFR (NE0 A DISTANCE Of Ti?REE" IAIMED THIRTY` (:130.0)
<br />Yl:[.! : 1I11.1sVL :iu.)1 t'H••rlulil r.. +s i..L J1.•: e/. L. •L .. .� v .w ..}n:.t t
<br />QUARTER A DISTANCE OF FIVE. HUNDRED TWENTY_ EIGHT (528.0) FEET:
<br />• •••••+•u ..�.,..t a•,L%#16LLL itt LHL halal Lllt11. Vr Sm.10 aumf( -HSI ',ual1 ILK
<br />(NEE ) A DISTANCE !�F THREE HUNDRED THIRTY (330.()) FEET, TO A
<br />POINT ON THE SOUTH LIVE OF SAID NORTHEAST QUARTER (NE4)',' "
<br />THLUCE EAST ALONG THE SOUTH LINE OF SAID NORTHEAST QUARTER (NE )
<br />A DISTANCE Or FI11L HUNDI=, TWENTY EIGHT (528.0) FEET, TO THE
<br />1'() I wr or HLf, i Nf: I t4(: , ALL IN PALL COUNTY, NEBRASKA,
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