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<br />LEGAL DESCRIPTION
<br />Lot Five (5) and Lot Six (6), "Wetzel's Subdivision ", of a part of the Southeast Quarter of the Southeast
<br />Quarter (SE1/4 SEl /4) of Section Eleven (11), in Township Eleven (11) North, Range Nine (9) West
<br />of the 6th P.M.. Hall County_ NehmQka
<br />)' STATE OF COLORADO a
<br />00910848
<br />1
<br />= Stale of Colorado SuicFiItNo__._..,-,.1' ' L.- _... - - -.
<br />CERTIFICATE OF DEATH
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<br />1 ,. _.,�.- ^- sn•- , -="r'- .�-�-_ ».:.. .-. -�->•- .tic_— ..... x._. _- � >nTr, -'A'= wee- r^.�G:_ - • F
<br />I, . COUNTY a. STATE -- A. COUNTY nn T.. •, )
<br />-I Denver ' brtt Hall
<br />b.;., CITY, TOWN., ON LOCATION • Lstorm er siay P, lb::; CITY. TOWN, OR LOCATION -
<br />Denver 2 uetks Grand Island
<br />d, NAME O► U/ w.( iw A- vital, fin woo addTrN) .�;.: iTrtcl[7 AOOwEss ,
<br />". .
<br />HOSPITAL OR
<br />cvr r.r )r15TI.I.•Tlp�l �t -. €.tlkE!� 1 €fSS� i!'(i,l 305 Wt±t'2e 1 Avenue
<br />..n e, It PLAI•c or DEATH INSIDE CITY LIMITST a. 1s RX01004CE INSIDE CITY 1.7.ITs, 7 la wts,OENcz oN A r.wu
<br />s ,a YES 4( No O Yci t) No ti YES t7 tr0 r
<br />s• DECEASED .' fYYd XidJl. lalt a. Days .NAwtk Dar
<br />dw
<br />- � Irvy. ca l +iwn Joseph 14arold Wolf DEATH June Q 1965
<br />1. AOE • y.,Ir.. .%�.
<br />f. sox s. co�ow OR wwcE T. MAwwfcJCp} )4ave No "to �. OATS; OP arRTYi Ir W , w :.
<br />IeAt DlrlAd.Yi At..Aw/QAR may, -�� [ At—
<br />Maly Whlte .rroewe00 Mwa►rao� Ajlri1 4',y 1`31.2 53 }
<br />10.. USUAL occue.T10 1 (thy A, If LOA. awo 00 a Mgtl Mt ORWItt", II, &IRTNPLA" (,%a$# .r I. Jfa r"ntry) _. It. vCITITEN Or WHAT COIIYTw.'
<br />r„rk don dlr, Ap II,A.t e/ w..rhM ...
<br />i - tJe,rrrwl /.rrr..i) €:1Cctr.iGi Mobile Hof-es Kissouri U A
<br />11. ►ATHEw's NAME It,' "OMER`s :MAtDOa :44445 ..-
<br />Sanuel David Golf Gertrude }lather
<br />1Y. WAS otCEASCD tvtw IN U. s. AwwlEO roweEST I4. vow" ate:�ualrrws, It, IN,1'4RMAMT A,fd.... f
<br />(f•r., Vie, er Mnkasew)( / /YN. yi rr w'aTn dw,.►/kYi.r)
<br />-- no 496-02w7-10114.:::, V' V. Wolf. G And Is and
<br />INTERN AI wl' it. CAUSE CAUSE M DEATH I£9C ST. ea+eawrr f•r (iM A+ (*iI A4). and (t) € ONSET wlvD Or -....
<br />PART 1. MATH WAS GLUED ■YI -
<br />r• s IMMEDIATE CAAtsE (f)
<br />following surgicA1 Ctsrrection of aortic stenosis
<br />CoRmlWaw., u.I.r, lax To (A).....«..
<br />wlA rA fan ri« M
<br />above owas W.
<br />Mahwt Mr wwder.
<br />Iylwr ear.. i". out TD (e)
<br />OTNt .aAVtrICwNT CO.arw. a cssrwew!'f.w T-aQ—Ar w Q. Zttb VO TOMS iEle.:»H.. asf/IU Cs.01riO.i ar:b: w w:� wu: n...�
<br />V IAwt 1(a) raw
<br />rEa 11 �~.wr rX
<br />1 t0.. ACCIDENT SVICIOC HOMICI 30D. Divemist NOW INIUw♦ 6CCUR"i'm -(7.01 .41.1. a/ IA /wry Iw a.t f•+r ;,;7r lfrw IR I -�
<br />E U C f1
<br />� . toe. TI-C Of It", NuwlA, Day.
<br />INJURY
<br />u-.... _....._�...�_.�..._.......� ._ ._ - - - t.f c_•.... - --- _...__ I.
<br />TOd. INIIIwYOCCu i io.. PLACE Or IAATUMY ( 1.I od.W toI C /Y'Y, TOWN<G1R LDC►TIoN CtjNry ST.Tt E
<br />WNR.L AT NOT ww t 4Z. Z. J.rlMy ,q. Jur b0ft-
<br />WOPK Ii AT Wowx (I H'.)
<br />1 Ntr Ad.d. IA. drr nrd /sew R_457+ .111 Iw+ Z . tl. a sjDeath neered el —
<br />AS ZI,T/r .4#14 •b.N; 044 N Hr br.t r/ r.y kw eJ+.ly., l IN, 0••'•4.
<br />Zia. Sf�,r+_ATURE (Dgr.r or $04) t2A. ADORCtS - - 22e. oAtt 110'..t II
<br />® t34. nr,.IVI„ Cn••.rq+y 916, "TE ba. NMdt OP Ct"CreaY on 4:1W4414131111 itd. LOCATION X.4, Irrw, w rota,, I.,IMr
<br />� IesMOY t1P/Ns)
<br />lte va 9 -65 G and' Islaa-d Nebraska
<br />f1• P AL M s ♦ agent" 04" 'O. OT .UPCA6 W6. "S'S syOrtA 1101"
<br />r 00 -l6tiz St, JUN 14 WS r /(Aj x C�-.� -..�• ��.
<br />THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD WHICH IS IN MY CUSTODY.
<br />DATE ISSUED y (�('{
<br />AUG .L 20 i1 U CaRUL J. GARRETr, FED.
<br />It STA'M REGISTRAR E�
<br />Do not accept unless prepared on security paper with engraved border displaying the Colorado state
<br />seal and signature of the >Registrar. PI*NA1Ti' BY i.AW, Section' 25- 2 -11$, Colorado Revised
<br />Qtatntre t0Q7 ,(• r,nrenn wlr ®.,� ._.. :.. .._ ...._ _..
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