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90107084
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Last modified
10/21/2011 1:01:42 AM
Creation date
10/20/2005 10:11:16 PM
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DEEDS
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90107084
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'«r'yrll'!F 1 c'7t� Emu"1�ri.,.iru... <br />r1 <br />•i <br />, <br />! 1. <br />11r <br />90-107084 <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 />DATE OF ISSUANCE <br />1981 <br />5EP 2 Z STANLEY S. COOPER, DIRECTOR <br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS <br />STAR OF NRRRR.SMA- 0pAWOM OF KUM <br />UK" W VITAL STATISTICS <br />CERTIFICATE OF DEATH <br />IMOVINT-mill #6111111 tome WE 1 <br />1 D <br />DATE 60 DEAN (me, w/. r/ 1 <br />DALE KLAVON M <br />MALE 1 <br />1, SEPTEMBER 1, 1987 <br />IWI -(.•. While. Gink AwkM D <br />DD0 offliKENT(. f.,11.1i.n.M..Mr, A <br />AGE -M.. Tiwq U <br />UN T ART U <br />U FR I DAY D <br />DAIIOP IMTNIMO.D.,,Yr ) <br />AIDE. DAYS N <br />NCIU1S. AYNs <br />I.II.w,.t.)(Sl.JIl O <br />OINy...N)(fMVur) I <br />Irnl A <br />WHITE A <br />AMERICAN 5 <br />57 A <br />AUGUST OF 1930 <br />CI A m STATE Of WITH IN Not- NA. CITIZEN OrWIMY OUNT 1MID.N ISMAIIII D, WWIofsmus[Io- is.•.w...A.wM/ <br />.... IM.IIr) \nOOW" DIM0RCI11(31.«11,) <br />S • U.S.A. to MARRIED II CLARA S UTE <br />W IICU Tiumsel U UAI OCCUrATNYI IG Sind d..1\ 11... d.nq....t I1MOQ1� Y 111OUMS► CC111NTY d DMTN <br />al.wipt ode. l <br />l:. 507 -30 -8943 12. us BAKER 1.1� LANCASTER <br />C lY. TCIWN W It3CA ION Cl/ DIATN I <br />INSIDT CIT!1 SIwIS 1 <br />110311 /Al OR OTNIS INSfITUIION -N.y (NANb.NIN. It ..OY d tMl wM... 004 <br />I31.11/1YN.I N.) • <br />•....kN1..i...RM '0..N..wEww M.M...w1 /►w• /1 <br />14b LINCOLN I <br />I1.. YES , <br />,4o. BRYAN MEMO IAL HOSPITAL I INPATIENT <br />243IDENCI -STATE C <br />CCIUNT'r C <br />COW. TDIII►IOIDCATICIN STRIET AND NYAtfll IIf1101 CITY Imil?S <br />33.. NEBRASKA O <br />On HALL 1 <br />- 31«J Y « «N.i <br />Wome <br />Fifty E <br />�Nsd 2 <br />EDWARD L D <br />DITTER <br />WAS DECEASED EY[16 IN IS 3 A4MID POKES? I <br />IN /ORNANT. NNM1- Rf1Ail0NfN1► - MANSNG ADO11133 IftNll IJ• •1 O No. tot. OT TOWN. 5fAl1. [111 <br />R...w q...p.....144 <br />u.NO i <br />it WIFE: CLARA KLAVON. 2310 W 11TH ST., _GR11ND i 5'LAND Nf,_ <br />SUIIALCI.A..Y.A.R.I.N.1 A <br />A C <br />CEM111RYCMCREMAT0RY -NAME LOCATION COOT CMlow" STATE <br />n,BURIAL 2 <br />2oR SEPT. 5, 1987 T <br />TOMGRAND ISLAND CITY CEMETERY 216f GRAND ISLAND. NEBRASKA <br />E 1 -f fuRf O Nt I NO / <br />6-7 T <br />T LIVINGSTON- SONDERMANN F.H.. GRAND ISLAND NEBRASKA <br />OAR Of DEATH (AM.. Der. ft.) t <br />t DA IM. IHr• .) N <br />NOUN DIA N <br />23.. 9 <br />IN 2d M <br />M <br />DA (M.. 0.r. 11I N A N $ <br />ITONOUNCID•IAD ► <br />► /ONOYNC DIAD(N...1 <br />23r 9 <br />E 117. <br />j •. M ►.1144 11 1... .. 1 « ..r.AN. W M. w W ! a A. IIr.44 . <br />.wwN..w w / «..wy..Y ... qq <br />.."Mot .NW <br />i <br />16111 PMISICI f I YSILI <br />S. A <br />t A <br />AIR C IVID SY R/ ISTRAE (AI.. ,. Y, 1 <br />S EP 1 1 1987 <br />OAT A E f(11Tf ONI ONI CAUff ► R LINE IOR (.). f ►1. AND (d! , Mw...l ....... ,,,...y �.A <br />f akp nLe Aewr4 diAewe wUA Old 09 &249&1 CnPlydinP 1 4AIM s <br />- DUE TO, 01 AS A CONSEQUENCE oT <br />�fLl/A071Q/U� � <br />,�, � <br />out TO. (A AS A C0NfE0ulma OT ! I.I...N.....M MNI ... ,... <br />,,, N�plzei�aaulineled,� <br />►APT • ANi s - <w1.AN...+\..Iry •...IA M..r ,...n11 II.1 IM 11 IIAWt wA{ Iwlet A AYty /Y WM CAN NIINID IO WOICAI <br />ITIGNA11f,1 IM 111 I 3 Np11N31 IIA«1. ►« « NN Er4w11. M CO.ONI• <br />.: 1• :. ' <br />F4.. <br />, <br />F <br />F4.. <br />, <br />F <br />
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