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<br />i
<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 />DAT S U E
<br />CT
<br />STANLEY S. COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA `BUREAU OF VITAL STATISTICS ,f
<br />Im"k -1T e L =-!57,
<br />: 89— 102779 —�.
<br />STATE Oi NESItAS1U- O!ErARTMtNT OF IIEALTN ReS of Per
<br />OUREAU Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH ._�
<br />OEC10ENi -N 11 t - —'- --f E_ - pA EO A M (Ma . Dow'. t.!
<br />Ellen Laferne Hackman Female September 23. 1987
<br />-w hi RIM\. At..I•a.. OMOIN /OISCENI I. R . Ihlnw, M., t.w. Aut - t.. /•wy., UNDER 1 VEAR UNDER 1 DAV OAT! OF WIN (Me. 00►. If !
<br />aJR0./.b1 G.r.rw.,.c Ifs,.e. /,I / J 78 3 . DAYS 1/OUIS: A11NS
<br />White 3 American « ,June 23. 1904
<br />t AND TA R 0► RN1M ( .M.. !/ f A . Ct111'Rt•4CM' wetAT :C NTRV MARMEO. NEVER,AAR all D.
<br />NAM1 0113 ►OU$1(it .40. RM atio.d.A w.wN
<br />Rome Co.*") WIOOWlD.DIvORCED /3r...f/) August E. Hackman
<br />R Elba, Nebraska . S. A. 10 Married 11 R
<br />SOCIAL 3ECUMTV NUM1 /R usuA{ OCCU/A,110N (C,a.. &..d at ~6 d.w. dtr�•••R •�A/I RIND CM tustNESS OR INDUSTRI• COUNTY O► OIATN
<br />of bag .....(•.1.r,d, investment Co. ,a Hall
<br />�? 721 -14 -2871 ts.ecretary _ u
<br />1NSID! (IlT PMtT9 I IIOS►1TAt OR OTHER IN311TUTION -- Wttr It! AN •w.•IMr 1/ NQ3l• O1 rM11 r.dr,., fIOA
<br />C ItV, fOWN OR IOC Af10N OF DEATH p.rp.w.rtr• A. rq...,.I H..rd,.
<br />rS, «.h... «N.I 1.wI. t..dw.M.•I
<br />,u Grand Island _- _ �Ik Yes Tod 1 rancis Medical Center Isep'lapatient
<br />INSIDE CITY LIMITS
<br />1t310ENC! -STATE COUNTV IC TT fITOWN OR LOCAIIOM S1R117 AND NUMBER 13An,I �, �. N.!
<br />,
<br />,Nebraska ,3. Hall !,3, Grand Island _ Isd 2409 W• Charles $t. 13, e`__
<br />A N - N . _. _ ran � ' MOTM� MAtOEM NAM! %1� -I RE -- _—VAR
<br />Walter _ _ -- Riness. Jane - -- Welsh
<br />1 _ Af;0?4 -- - - (slnle+ w a t o NGoppapn CN TOWN. SIAII SIP)
<br />., wAl OECEASEO EvEE IN U S A/AA10 /t3RClS� INIORMANI -NAME • RE /AfIC1HSNlI -• MAt11Nli AOORESS T Bland, NE. V Rao'
<br />«......►� 1.l ..,• +..•.w.pw.•+.•,.w _ Hackman- Husband- 2409-�c• unarles .7C.- Giiriit�
<br />SR No IlAugust E. _._
<br />CIPt OR TOWN STATE
<br />1URIA1. Gh.KN•.w b..,wT pAT1 '+MFiui: a CEEjiiTv':'f
<br />Sept. 2S, 1987, Central Nebraska Crematory ��,� Gibbon, Nebraska
<br />iq,r _Cre=tion 30r i01 _ -_ ___ 2 ,,Q rno.IO«Ir.,lue Itn
<br />A R- .`WATUI • SK1NN NO lullE�Ai MOMt - NAMt Ak1i iDMEf3 lir`Aiti RR • �88h'
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<br />'..:_�:J f__A __ Anfa1- Rtstle•r- G8,Ades 1123 W. 2ad,,. _Grand Islan ,
<br />Davi -d R. Cronk,M.D- g08 N.
<br />►�Ri
<br />C�
<br />1'-I)U1 Tp -46 AS A C014SEQUIMCI OF
<br />0UE TO, OR AS A CONSIOUINC! Or
<br />«4.y w ,in.drr
<br />- 'T;.fa M
<br />►RQ 5C 04CEODEADINO... -i
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