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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT ERTIRES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RED. ORD OIV FILE 3MTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTS K, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ApJ�
<br />DATE OF ISSUANCE 44
<br />nn q i41VL YS_ COOPER
<br />LINCOLN, BRLi4o SKA 2 0 0110 9 4 S HEALTH AND HUMAN SERVICES SI YST�E�
<br />STATE OF NEBRASXA- DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS ,f 7 CERTIFICATF nF nFATIS n - _ `�
<br />DECEDENT—NAME Fits MIDDLE a DATE Of DEATH (Me.. Der, Y'.)
<br />T Eldon Otho Dent 12. Male December 26, 1987
<br />LACE —(*.S-. While. $IwcL A.Mwx w OMG1N (DESCENT(e.g..Metiew.Mewicew. AGE —tr u ..Ad.r
<br />Iwiww, M*J (Spes.l1) G«.ew. McJ (5P«dp) (Yn.)
<br />UNDER I YEAR UNDER I DAY
<br />DATE Of R:RTN (Me., D.F. Y'.)
<br />MOS. DAYS wwas AUNS.
<br />White American �� 72
<br />.
<br />Aug. 24,
<br />S. 6e
<br />fa
<br />T 1915
<br />C AND ATE or OWYN (IF eW :w U.S.A., CITI2EN OF WHAT COON: RT
<br />MARRIED, NEVER MARRIED,
<br />NAME OF SPOUSE (If ode, pin wNr:dew weave) --
<br />•e•'••••'•A7)
<br />Bu el? - Nphrark U.S.A.
<br />WIDOWED, DlSp «ifr)
<br />Mare
<br />Evelyne
<br />A -
<br />,Q
<br />Bishcr
<br />SOCIAL SKulm NUM{ER
<br />USUAL OCCUPATION (Give kid of "A dews d«iwp .ea
<br />RIND Of BUSINESS OR INDUSTRY
<br />� �OtINTY Of DEATH
<br />,2. 505 -14 -6739
<br />of "'G.9#-fe, ev.wdnbred)
<br />12e. ?armor 73
<br />112b_ Agriculture
<br />,,,, Hall
<br />CITY, TOWN Ot LOCATION OF DEATH
<br />INSIDE CITY LIMITS
<br />Y
<br />HOSPITAL OR OTHER INSTITUTION — Nowe (If wW iw .ilker,
<br />M NOW W e:ST. h4ka v OOA, /
<br />O'ope te1�
<br />Grand Island
<br />n «Ne/
<br />° Ye
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<br />yin a rwlN r/
<br />Medical
<br />/E.... � . I'"—
<br />.
<br />,� rancis Center
<br />,w Inpatient
<br />RESIOENC! —STATE COUNTY
<br />CnY,TOWN ORLOCATION STREET AND NUMBER tNS10ECITYLfRUTS
<br />,s., Nebraska ,w Hall
<br />lSp«'" Y «NO)
<br />,S, Grand Island ,x.4204 New York Ave. Iti e►cu
<br />— W MOTHER —MAIDEN NAME f LAST
<br />Claud -- Dent Edith -- Johnscn
<br />_
<br />WAS DKEASED CM M U.S. ARMED FORCES? INFORMANT— NAME — RELATIONSHIP, — MAKING ADDRESS (STREE101 RAY O. NO.. CT OR TOWN,
<br />►�
<br />Oy(33111
<br />Is. No „Evelyne Dent - Wife -4204 New York Ave. -Grand Island,
<br />CURIAL, CrerMMw,
<br />Dec. 30, 1987
<br />CEMETERY OR CREMATORT— NAME LOCATION CITY OR TrnwN STATE
<br />,p_Burial
<br />2p►.
<br />2(k. WestlaTJE1 Memorial Park O,,. Grand Island, Nebraska
<br />FUNERAL NOME —NAME AND ADDRESS (STREET OR R.T.p NO.. CITY OR TOWN, STATE. 11"
<br />l C f
<br />2T.pfel-
<br />Butler- Geddes 1123 W. 2nd, Grand Island, NE. 6880
<br />DATE fm . T'.Vj I
<br />DA (Me. Der, r'.) HOUR
<br />OF DEATH
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<br />1,01-14 If ?
<br />HOUR Of DEATH
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<br />PRONOUNCED DEAD ►RONOUPKEO
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<br />DEAD (Her.)
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<br />Be �rj K -71/fo0. ti 44,U. oSf -7r.4 e - J Iyf rco / °b'�° f. Grand Island, NE.
<br />a►Te BE BY REGI RAR (M..,
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<br />+.. MwIRE . DATE a woumv (M., per, r..) Noun of INJURY wutRRE NDW wuRY OC:uRRep — "-
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<br />LOCA'ION PER" W I.P.IS II.. CITY OR TOWN STATE
<br />(30s.
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