|
1 WHEN THIS COPY-,CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />1 DEPARTMEN OF HEALTH, IT CERTIFIES THE BELOW TO BE A -TRUE COPY
<br />OF AN OR1G- ZgAL':�CORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VTTAL.�STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS..
<br />Q n e�♦
<br />DATE OF ISSUANM. ) 89-� -
<br />E� STANLEY S. COOPER, 'DIRECTOR"
<br />LINCOLN, NEDEM5 A. BURE.AV.OF VITAL STATISTICS
<br />The Easter l y. �orty(40) , Feet .of Lot . Seven (7) ,J j,in Block
<br />Sixty- Three - (GA.),, in Wheeler acid Be=et~ tls A'ion +a the. City" "
<br />Grand Ys1a Hall County,, ��ttrasira.
<br />STA?E OF MENRA�IU -wrx EMi B
<br />x i iff4LTN
<br />WN N OF MAL StAn$ C!
<br />CERTIFICATE OF DEATH
<br />r.
<br />F
<br />(a f/tLLG j7�i.�ft(l1tl� -ic� �uf.�AL/�� ;
<br />QW1 ( I.Awas SNWM a• awlalaaar dath
<br />OU! t0 CI! AA C EfICe affi<. ! bimma,alw•. "w a" 4016
<br />Aa
<br />VAST WIMa.1490Waa•,w lNA,./ r.•aagad I /YIN if rf"r. WA, "Oft A I AMR; WAU CANWHO&
<br />N 14#141 bC�i( 1. •��w:r�s.nassr rwwars>r fllN+gr ry ar M/ l7fMlw�Mf O� C T
<br />t1�a1 T« a/ /il•1
<br />4 Tic : 7 ►t. ['J . » �� S n
<br />• +KC10law. lNtMR [re.111.1/ /Mt y w1uM Ian► D+►.r 11G`A or iwu`l�f► `"°� o'c�S'C`11! �-,u1MT oCGY1Mp
<br />an Iss"4)
<br />L
<br />J
<br />� +S
<br />• aaaas.
<br />t
<br />1P4
<br />x_ -1t
<br />it
<br />r.
<br />I
<br />OCCUMPIT-14AW flat WDOU
<br />DA (M,, per, Ti.) .
<br />= Arlis FSci f/ Middleton
<br />E
<br />x January 30, 1981r
<br />RA — (• t , w iW .. OEYaOf T'i• l..11•tiM. M•aicM,
<br />iMr«awaaJ1.111i:.a�h1 rrn)
<br />—1•r SW"M UNDE>4 n . - U DAY
<br />Mom., ;, pan Noels
<br />DA 1 N fN•.. r. V..) ,
<br />White 1.. erica 40.
<br />72 p, &.
<br />,June 4, .1914'.
<br />CIIV AND STATE OflIET11 (IF aN,r6/SA,
<br />CITIE1NOF WHAT NTET
<br />1-
<br />O,NEVElMAMHD;
<br />MAWOFSPW59(I(w&,jjm "deft •er)
<br />=ME Cava")
<br />EI.Whittiniton. Arkansas'
<br />USA
<br />WIDOWED. DTVOECED(S,•a71ys
<br />to Mgrried
<br />,Clarel K. Wishart .
<br />3M1AtSECUE1TTNUMM!
<br />4 MILCQCV14IAtiD M(G" Mad dwvtiiM.r.r:aesWP I KIND OfSUSINISig IMDUSTV
<br />COUMTTWOIAtN
<br />,,,512 -03 -4245
<br />l lu 10NUta v r Constructiors
<br />1,110. Douglas
<br />CTIT, TOWN ONtOCAT"MOffth"I
<br />IP4M'CIry MUM •It" 141,01 OTHER INSTITUIMM- Ob~ (if aowevOrr•
<br />MwOS►OTINSt.Wkwppz
<br />.ver.rr,s . tq
<br />rOmaha 1�,m,:
<br />Inpatient
<br />des w. n sg-
<br />-
<br />DlSIOENC! -fTAn COUNTY
<br />CITT.ToMNOstOCATIOM
<br />ATR(ETANDN1lom ..
<br />I%1lIDE alrtTUAWTi
<br />Hall
<br />11SEGrand Island
<br />East I2th Street
<br />15.,Nebraska Is.
<br />1
<br />— My
<br />MOTH E —MAI RNA" May LAW
<br />T James Thown! Middleton
<br />1L Sarah Lawrence
<br />WAA DECEASED
<br />Oft +•. «.w)
<br />Oft M UI.a AAAST(1 vamll _
<br />to �,i1, .•r Y� «M./.AfMlll. ..
<br />INFOEA -Mr- NAME- fEfAT10fISN11- 11RJlR10 AS (311!1; CN 1 f!. ND.. CITT of 1y 1�f,1 ru tMJi
<br />O�ijU
<br />is No
<br />I,Clarel Mddleton: Wife: 303 Ea 12th Grand Islam„.
<br />sUNALCISM-MR.
<br />cEaumonCRE"Toor. -1w"
<br />Larkno" CITYOlTowN $1#4111
<br />...Burial
<br />m2 -2 -1907!
<br />Viand Island Cemetery
<br />,,,,Grand Island, Nebraska
<br />!F NO . -
<br />TUNIwa "a - NAM( AND ADDRESS "IFF co TFA NC, CT OR IRA'% STATE, 19 g80 t '
<br />- /
<br />Butler- Geddes: 1123 W..Znd: Grand Island, NB
<br />21. -Sir
<br />nApfel-
<br />"a Of D"I" GMf.. Div. T,.y
<br />r. If, !
<br />"OUR of MAIM
<br />'/ of 61
<br />27..
<br />M
<br />r.) HOUR
<br />M,
<br />OF WATR
<br />04
<br />f/ONOY►KEDOfAO fI1pNOtiNCE00EA0(H•w)
<br />i
<br />�
<br />It. w yM�Y. 1.ara a«•a.f MILY `A.r aT•/,1�, M 1. w .
<br />••«a1�1Mt
<br />i
<br />O. r ill" d aaa,•Y,11a•.•�Jlla w...y.r.� Y MMiM //.M MIrnM M
<br />M• IlnablMt�
<br />(fi,•,aa. awt IEYy� Ail a A»
<br />�! �
<br />,lr,•a11wa•A»aa•«MaNI•i
<br />240.1 W rat)
<br />1 ( (oe ss nM)
<br />Sherrill Murphy M.-D-. University Hospital: Omaha, Nebraska
<br />P
<br />CAT JAW., r, Ir.)
<br />,.I . :. , •
<br />FEB IM
<br />(a f/tLLG j7�i.�ft(l1tl� -ic� �uf.�AL/�� ;
<br />QW1 ( I.Awas SNWM a• awlalaaar dath
<br />OU! t0 CI! AA C EfICe affi<. ! bimma,alw•. "w a" 4016
<br />Aa
<br />VAST WIMa.1490Waa•,w lNA,./ r.•aagad I /YIN if rf"r. WA, "Oft A I AMR; WAU CANWHO&
<br />N 14#141 bC�i( 1. •��w:r�s.nassr rwwars>r fllN+gr ry ar M/ l7fMlw�Mf O� C T
<br />t1�a1 T« a/ /il•1
<br />4 Tic : 7 ►t. ['J . » �� S n
<br />• +KC10law. lNtMR [re.111.1/ /Mt y w1uM Ian► D+►.r 11G`A or iwu`l�f► `"°� o'c�S'C`11! �-,u1MT oCGY1Mp
<br />an Iss"4)
<br />L
<br />J
<br />� +S
<br />• aaaas.
<br />t
<br />1P4
<br />x_ -1t
<br />it
<br />r.
<br />I
<br />
|