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<br /> " ENnn4' "CAWWSTIE"5ED3MOF774EMMW#ffALTK,AftI0E#A4 RyKXS
<br /> SnnW !T CMr*P-S THE BaOW TO aE A TRUE COPY OF THE ORKWAL jtEdwQM#*A4Mw.
<br /> THE NEBRASKA AEALTH AND MWAN SERVXX8 SYSTEM, VITAL STA
<br /> THE LEGAL DEPOMORYFOR VITAL MCORD& GATE OF 94tARN'CE
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<br /> 200009499
<br /> L^MAEw?Aw
<br /> lf/tLTNAM
<br /> SATE OF \ESRASFA•
<br /> DE?ART.%CEN-f OF NE1LT!? Al.'D Hi1MA*I
<br /> VITAL STATM-na T 7 V4
<br /> T
<br /> CERTMCATE of DEATH
<br /> . "rFi,E'.i ~AUC Frrr utQE LAS, 7 SEat•4.- AwOwTE (1F Giw
<br /> Opal Irene Schuett Fe*.nale_ Jul #u16 20
<br /> q•r A.Vp STATE :F ,r.pnVSA tiay?ryieK .GE•t"MM♦t IAQLRI YEAR, (/rpEw r par 6. DATE OF epTN AoW
<br /> r- Y b Z. n 7 r SP MOS r DAYS k .OURS • IM i L+ 1
<br /> O l: a 1.7. a r ' 2 1 3
<br /> TTSz<~L S_C`Ja,ry wjmd-K,
<br /> Y PLACE OF ]FAIN
<br /> 506-46-2378T" ❑ ` o±
<br /> W FACILITY. Hama r..,or p.. FX.ar aTCnr„p.q ❑ EA ate. ❑ PeFdocA
<br /> Lakeview Health & Rehabilitaefi iner ❑ °OA El «w,r
<br /> Y CITY TGY.rl OR L0CA1C^ {]F OEA-- I M -Vx O'TY TS a. 00C PLN YOT DEATH
<br /> Grdnd Island Y-Q W❑- Hall
<br /> +T. PES,DENGE -STAif i `9C LOIri?r ~k CTY To%VN OR LOCATry~ i,a.5TREETAMJNUUEIEA af+PAr VZOQo~yM tv NSrCE WY L"IS
<br /> Nebraska Hall Cairo ► 408 S. Said 68824 I T.,®
<br /> a aACp .;Iq.Nwe ~w. Lrrcan nar AM(ESTRT A S .Dun yre¢uL GrmrA.0 1,2~~E0 TpwOOWEO r3 NA1.E OF SPOUSE AT -ft er, •Sox+M rSO-00 L a+~..erl.urw
<br /> _White_ German NEVER a.YoRcEO
<br /> Ida .;SyALO(.CLNATQN rFw ..lL d..w tu~+►c+v.y ~av 14p KIND OF OUSIIESS ImOUjTRY 15 ADUGITON 1${ pW.,, y7a0t cp'1,PwA01
<br /> -Q -10 _ Coordinator Senior Citizen Center E""~'~s"°"'"r °r~' `°1"'°"""
<br /> rb FA fnFa, NAML• irT$7 wDOLE LAST r~ MO rEti R1E17 R FIRST YIIDOLE YAOEN SURNAWE
<br /> Charles Kern tar- E1 ha Hadgson
<br /> •n WAS OEUASfO E' ER &4WD K[ EST 1 9a rd-OpMWT %AAtE
<br /> rn w v I ~ i. r.,s v:..r .r,tl ams ca xrvcaP
<br /> no Sherry Kissler
<br /> : 1.)LmMI VAILCrG ADDRESS ~stA TPR DNG.CTir OA TOWN STATE
<br /> P.O. Box 73, Cairo, Nebraska 68824
<br /> n -e-S.LMER Sr;:.A, ALCENSE rq I,. MET,.]DOFDTSPOyTry, 110 DATE tre CEUVOW OR CRf.r•ro NAME
<br /> PJ7 7,I,_j
<br /> ' L 1 ❑ -i ju 2G 200 C.N.C.S.
<br /> 7 :NL LW-V,. NAVE - Zle CEmETERT OR(REMATOAT LOCATION C,1, OP row STATE
<br /> Apfel Funera Home ❑ ! Gibbon Nebraska
<br /> 7~C FUNERwL:OM` AOONE55 ISTFIEEi OR RF D NO. Cr OA TCMP $TATI
<br /> 411 West 11th, Wood River Nebraska 68883
<br /> :q IrrAE TE CADSE fENiER ONLY ONE CAA15E .ER WC FOR W PA ANO" rw.r rrr...r, arvel .ne I..n~
<br /> Pu,r t •
<br /> - k k) yy) jw kIl" Gt~f ~f @ Z` [7.4v R_ C U ~,r nrr e C~ , n
<br /> OUE TO. CIR nS CO.51EauENCE OF
<br /> '
<br /> ly I,, A+.n..r b.r..rt o>w.Ib wan
<br /> -t' Y:,, & a o lt~L ! ~e P•~~
<br /> p C C
<br /> OVE TO, OR AS A CONSEOUFNCE: OF
<br /> ~W,v 1'~t ed a~2 Y~•., n.rn.n, pYM .N b..,
<br /> PART FrE ` ~a~ TIp.Y (~Cv '[gig p p~ ~~yp PART A 1c FEFW.E WAS THERE A ?a N1t OprY zy AS [A_ {FE•gAEp TO MEp1G1L
<br /> ° f@/l PREGNwNL`r IF TE PAST ] MONTHS' EX-XINER OA CORONER'S
<br /> -'Ea 1246 OF rkAiRr %v r, *Tl 12w Pour OF.uLA,T 2EQ-DE,C-mW-w OLLo T'XCUgFwD
<br /> ~+c
<br /> W E] x. +,.A,YiY AT YlOfb[ 1251. * wyORYar -y. pyre y FW 121q L• ar*ft STAEETOARFOND Cr CAfTow STATE
<br /> r••caI h.esw7+,v' ( rrs ❑ No ❑ _ Este C OF
<br /> j DATE OF DEATH TAIP D" Y.1 2Ea OATS bl. EO P40 DA, wl 128b T,L.E Or DEATr.
<br /> 27t O TE SIGNED 11AD CWT, rr~ 1T`TNW OF OEATn- 2Ec PgprFptiNOED DEAD I.Af. DAY, TY.J 73E FAONOLwtEtl DEAD AWN,
<br /> «Zra Tp.,•7.f: al mr ,r....,Tple wen n. Fn...1M WIA Mtl.Ty U.~ 2!. A.MpwaasaPr>aw.rwp - _
<br /> Pa/+.1^ nwn Rccu..I .
<br /> 4 Ca.net><>.va.e a ri V. I.n as Oll" W4 &4 0 to Cftd.W
<br /> ra rrr
<br /> 29 DC T06ACCG USE CO"' , ROVE~TST0EATW towu X. M OROAIT ON T ODNATION BEEN CONSOEPEOi 500 wA30ONSCMI GRANTED'
<br /> rES NO ID uron ❑ YES 0 ND ❑ VES ® NO
<br /> ' y"' ME AND ADDRESS tlFCERTIPIEA IPrn•gCuN.COI~ONERS~TSX]AN t1CW.TY ATTCANE-Tl •Y.p.vHn'
<br /> Steven L. Husen M.D, 2 LUD, G_I.:, NE 68803
<br /> U. ?EryStRAA m GATE FILED 5V WZ47W+ DIAL OW n,
<br /> JUL 24
<br /> LEGAL: The North Half of the South Half (N)SS)S)of Block Two (2) of
<br /> the Fourth Addition to the Town of Cairo, Hall County, Nebraska
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