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� r <br />sQ�B <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 PP.GAL DEPOSITORY FOR <br />r VITAL RECORDS. <br />1 DATE OF ISSUANCE <br />OCT 17 MO STANLEY 9: COOPER: DIRECTOR <br />LINCOLN, NEBRASKA BUREAU OF VIT4,',STATISTICS <br />STATE OF MWWRA —NVAN UM Oi Nmm <br />SUMM m MAI STATISTICS 8 3 05907, <br />CERTIFICATE OF DEATH N,y �� <br />George Frank ___r iiemoth Malls Hay 1983 <br />i•• 1• �1.If1A i1+ }Oi MI (• 0.� -af• N ! 1LN! 1 M t! OI N /AN.. Dar. tee j �- <br />' WAR r 't AYl. •t.1 /QN1 J <br />,.e Aaart .��t • , ►� , �® �ai �"110U Awn.; A ri1 4 1893 <br />'cnT M7AA M1N iM wf» Y.i�1.. N�1 �vr17L !r W1 I v!(R w17, P f WtDQ 0 aC•I M! OI SPQIDid( M.11. pi.. MrJ11 iMwNI <br />Merratic Coup Nebrsus U. S.A. arr`�eci Elise Buckow <br />SIC V[MA QCCU1PA (G1wk1•d .wrllr•dv.npwM 1R40OtSU3IMlSSpIW17USORt ,CO4NT1It),OlAN <br />u 507- 18"0437 S. Mans er �J rdp IC,.° 1�is agsport I H811 <br />CITr.TOWNDRt ATIONO[ TN tNilOtcmw�rs NOSMTAtOIIOTN l0INSTITUTWH- "g"(N•.l1.1MM". M110f►asW611Mw.w.00A. <br />(Spe rf•.N•1 R A'ood River es Iw tan Center , <br />SlSl inpatient UwI -SWAT[ COYMR ON. TOWN O WCATN�l1 ST41H AM NYMR[R <br />I[, Nebraska ,� Hall 115, Grand Island 15d 1815 W. 10th ' "S'a "rytlwTS <br />A _ N!R- AMIDlM I <br />Frank T. Nlemoth Alida C Ahrens <br />WAS aCfASlO [vss N(Y s AR11ID tORClRT INTOMIANT- MAA/l- ALUWIONSNIP- MAIt1t10 Aalt[u I81411 a 110 No Cm a tow" /1At, ,rl <br />1�.0 «-tl I» ". •- ....w..,N«....NI to Elise Niemoth -Wife -1815 W. 10th -Grand Island, NE.68801 <br />DUN". Cn•.«,1w, CRMItt OR CRlAIAlo'" - NAM' IOCAl1ON CIWr p TOWN Rtwr[ <br />rial Y 21, 1983 Westlawn M 1 1 <br />L <br />J <br />7 <br />t <br />t,. <br />I I <br />Al <br />d' <br />n <br />J- <br />[o► <br />Ph error a Park Ta Grand Island, Nebraska <br />O <br />YNI AI NOM - NAM AND AOORI S $fall p11 t 0 No . CQ► 01 qwN. f /All, tMl <br />tnApfel-Butler-Ceddes 1123 W. 2nd, Grand Island, NE.68801 ; <br />OA OSA 0•r. r..( <br />S <br />Y 3 <br />A (WON?, n.l - ._� <br />r <br />f SIGNED <br />- <br />2.. 24, <br />OSOON WAD N CMIA <br />1 (A.., o.r. r..) <br />I AMO.- (MN;MM.wy <br />1 <br />m. <br />• M bow ., <br />•...0) oW <br />zk, <br />« am. <br />M wO yOw <br />•w ,1.w...d 1.... Ay .1 <br />w yMM4.1 W6w. . t <br />we •/ w <br />JIAAJfPomhmo and Wei 0. <br />w�MrRWfOM1 fO1>. tU l+qfN• <br />AMMUSS OF C11 1 1 <br />j <br />tM qy..n,. •y rql <br />r A OY ry A N!r► (ITP� w IrMI� <br />C.D. McGrath M.D. 729 N. Custer, Grand Island, NE. 68801 <br />A 1117115ii,11110 R Pik 5- <br />I►A <br />�610F(ENFIR <br />ow COW <br />.[ I uAi T I.1. ( P. AND fol <br />1.4..•I ff1.Nf "w end do@& <br />-10L. 044A C4ft_ <br />AI <br />1 w M.fnN w.«.,N MM <br />S To, on AS A comimcwtoF, <br />L <br />J <br />7 <br />t <br />t,. <br />I I <br />Al <br />d' <br />n <br />J- <br />