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<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 DEPARTkWt:OF R9ALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITbRY '6R`
<br />VITAL RECORDS.
<br />�- 102313
<br />DATE OF ISSUANCE 8
<br />�� 2-3 STANLEy S,• COOPERa. UrR -'OR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL staiSITICS
<br />The West Four (4) Feet of Lot Five (5) and all of Lot Six (G), in Block Two (2),
<br />An Meves First Addition to the City of Grand Island; Hall County, Nebraska, excepting
<br />a certain tract deeded to James B. Campbell and Tamra L. Campbell, recorded as
<br />Document rie. : 7 104829. STATE OF IWWASKA_WARUKOIT OF RMTH
<br />8=W Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH ti
<br />OECEO(NT -.NAME Fib. 11 • ! . A 1 TH to.. Day. If)
<br />Evald. Christian Madsen 12 Male SI?ptember 15, 1988
<br />1ACE -(•D. While. �i• elA�v+ c�wl!J_-M101N(OEfCENTC.•.Mw1,ww.Mw.k.*. e- orr.ww.' uN01t /rEAe u/IUMIDAY OATECif801"ww.Der.r..)
<br />I.d.... wt 1(Spn,)r) k� - ) /fMt+hr)
<br />tyro MOS. OAri NOU1f . MINS Au • l0 , 1909
<br />. White (a. Danish » w 19 w k 'Aug.
<br />CITt AMP STATE or am" IN.N..UfA, CITIlEN 0WHATCOUNT IFTWIDOWED. "EVEN IVEO1Sr «d,) {)S
<br />NAME O/f/OE[NWdw, arm 00,t•AA..•)
<br />yw,. q•wh,)
<br />N sted, Nebraska • U•S.A. To Widowed IT
<br />SOCIAL fECUMTY "bX iEi USUAL OCCU /ATi011(Gn• bwld.wrh A.. d•nw•.••r KIND OF BUSINESS OR INOUSTry COUNtt W MAIN
<br />of .64'.9 M6.•.ww da,Mrd) Ha I 1
<br />,7 508- 46-F:. ia. ,�. Retired Farmer 17. Own Farm ..
<br />N I10.Owf,ST 1Aw.•OO.
<br />pr, TOWN 04tOCATON;7FF01AT" INSMCItt TAIOIOTNEIINST17UTHM -Nw 111"I M.MN.
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<br />,.Grand Island, :�ttraska 141 Yes 1,,d St. Francis Medical Center ItAo. Trn atient
<br />1E710ENC!- STATE " COUNTY CITY, TOWNO *LOCATION STlEETANpNUAIlt! INUM CITY LWATS
<br />(Sysi/,Twwme)
<br />u. Nebraska a t�• Hall its, Grand Island 11541 631 East Hemvii:a•L Dr. 'lu Yes
<br />A N -NAM! .. )I N1R- MA/OENNAMUI Nt3 _
<br />(dec) Hads C. Madsen , (dec) Ella Ida Sorensen
<br />WAS DECEASED EYES IN U S AIMED IAKEST INiORMANT- NAME - ![tATIONSN1r- MARINO ADDRESS (STNIJ 0 F a- NO. Cm 08 TOWN. FAIL ZW)
<br />" "' """'' "'•"'"•""�"'"`•� 1, TTai Ia Spiehs- Daughter -Box 144 R.R. �Il Cairo, Nebraska
<br />1s. No
<br />iUTiiAt. Cr.wo,iw.. R•w.Gwl' ?A C[MIT1/Y on CRTM►T()1T -NAME IOCAT)ON CITYgTOWN STATE
<br />a�. Burial. 70 9 -19 -88 Westlawn Memorial Cemeter Tor Grand Island, Nebraska
<br />I;Agl NwZSIGr'MAM A [)CEMI 1t0. /UN!!At NOVA -NAM! AND AODR[SS ($ALIT O• •, 0 HO, C•ir Of TOWN. SfAff. [Ifl
<br />3. �� Jacobsen Funeral Home 411 "0" Str. St. Paul, Nebraska
<br />}1 lR•f. DA N O(.Y Owr. r) HOUR OF DEATH
<br />1S1AN 04, D•, ri:t =�
<br />T. � f.
<br />' Set- tember 1? , 1988 Y 7... _ SAS _ M
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<br />w, Did Golan M.D. P.O. Box 2339, Grand Island, NE r1 68802
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