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<br /> Part ot the Southeast Quarter of the Southeast Quarter(SE'/.SE'/.)of Section Eight(8),Township Eleven(11)North,Range Nine(9)West of the 6th P.M.,
<br /> Hall County,Nebraska,described as follows: Beginning at a point on the South line of said Section 34 rods West of its Southeast corner running thence West ��O
<br /> on said South line 7 rods and 9:4 feet;thence North 12 rods,thence East 7 rods and 9h feet and thence South 12 rods to the place of beginning excepting the
<br /> North 60 feet of said tract,and also subJect to CouMy road covering the South 2 rods of the above described tract;and also Lot Two Hundred Seventy-Nine
<br /> (279)in West Lawn,an AddiGon to the City of Grand Island,Hall County,Nebraska,excepting the Nath 60 feet of said bt,said Lot 279 lyi�p East oi and
<br /> adjoining the above desc�ibed trect;aU of said premises being within the corporate limits of the City of Grand Island,Nebraska.
<br /> WJ�V 7!�CAM'CAI�ES THE RAf3ED SEAL QF T/�A�ItASKA sTATE a�l�-G� �4
<br /> T/
<br /> /T CERTiES THE�ELOW 70 SE A TRUE CQIY QF AN ORK�NNAL Rl�df��� X�.���� -�`=:
<br /> p�AR71NENT Of HEALTH,6UREAU Of V/TAL S7AT/ST/CS WHM.i//S TE�LE�AL:L��fOR �
<br /> V/'/AL RECORDS. __ =
<br /> _�- - -__ _- _� �
<br /> DATE Of/SSUANCE �/��r�� � - - - �
<br /> V �1�� =� ` rt,Qppg'q
<br /> FEB 31�7 ASS7STAN�S7'l47,�!��TR�R
<br /> UNCOW,NEBRASKA NEBRASI�DE���rH
<br /> __ -- ._ _._ _ --• _ -
<br /> STATE OF NEBRASKA-DEPARTMENT OF�A4ThF : -= � -"`
<br /> BUREAU OF VITAL STATISTICS ---_-_ __ _
<br /> CERTIFICATE OF DEATH -
<br /> 1.OECEDENT-NAME FIRST MIDDLE UST 2.SEX 3.DATE OF DEATH /MO�ln.Day.YBarl
<br /> Lillian Ma lena Anderson Female Jan 21 1997
<br /> �.dTV AND STATE Of BIRTH !ll nd ir U.S.A.name cOUnhy! Se.AGE-Wt BiNMay UNDER 1 YEAR UNDER t DAV 6.DATE OF BIHTH /Ma�tl�.Day.veerl
<br /> (yrg,� �� Sb.MOS. DAVS Sc.HOURS� MINS TUne 4 1922
<br /> Fairfax South Dakota �
<br /> L SOCIAL SECURTIV NUMBER Ba.PLACE OF DEA7H
<br /> HOSPITAL: � ��Da�ieM OTHER. � Nurs�ng Home
<br /> 508-30-7599 � ER o,,,�,;e,„ ❑ �,,,�a
<br /> ep.fACWTY-Neme lIl ia1 rnsfiNlim.grve sbeef and numbsrl
<br /> Mettioaist xospita]. � °°A ° �'�,S`��ty�
<br /> !C.CITV.TOWN OR LOCATION OF DEATH 8tl.INSIDE CITY LIMITS Be.COUNTV Of DEATH
<br /> Qnaha Y� � N� ❑ Douglas
<br /> !t qE$IDENCE-STATE 9b.CWNTY 9c.CITV,TOWN Ofi LOCATION 9d.STREET AND NUMBER /IncludiigZp Cade! 9e.�NSIDE CITV UMITS
<br /> l��Jlas� k.Ameriten MWian.��� CESTRY 18.9..n�.�xiCe�GxmM�c�ysland MARPoED 192�WED �13.N�Of SPOUSE 68803 �M�� No�
<br /> 10.RACE le.g..WM�e.Blac � ❑
<br /> V��e' ISPeaNI NEVER DIVORCED �Wlen(��.] J� p,nderson
<br /> AMer'iCari M
<br /> 1N.USUAL OCCUPATION /Gne kiMd�ork tlnne dein9 mast 10D.KIND OF BUSINESS INDUS7RV 15.EOUCATION (SpeciN only MgReat 9����^P��) q4
<br /> o/workrng lile.aven il reMedl � Elemenwry«Secandary 10-12) Co�ge I t-4 a 5'I �
<br /> ✓Registered Nurse Nursin s
<br /> 18.FATHER-NAME FIRST MIDDLE UST 77 MOTHER FIRST MIDDLE MAIDEN SURNAME
<br /> Carl Wa er Maria Krueger
<br /> tt.W�S DECEASED EVER IN U.S.ARMED FORCES? 19a.INFORMANT-NAME
<br /> *��vss.no.or unk.� Ilf yes.grve war an0 dates ot aervices� ���ce J. Anderson
<br /> 19�NFORMANT MAILING ADDRESS (STREET OR R.F.D.NO..CITY OR TOWN.STATE.ZIPI
<br /> 1924 West 13th Street Grand Island NE 68803
<br /> 20.EMBALMER-SIGNATURE 8 LICENSE NO. 21a.METHODOF DISPOSITiON 21b.DATE 21c.CEMETERV OR CREMATORV-NAME
<br /> �t �}�� ��,,;e, �Re�noval Jan. 22 1997 Lincoln Memorial Cremato
<br /> 22s.FUNERAI HOME-NAME 21E.CEMETERY OA CAEMATORV LOCATION CITV OR 70WN STATE
<br /> fel-Butler-Geddes Ftuleral H °feni�" �°onaio" Lincoln NE
<br /> 22p.FUNERAL HOME ADDRESS (STREET OR R.F.D.NO..C�TV OR TOWN,STATE,ZIP)
<br /> 1123 [�lest Second Street Grand Island �' 688�� i IntervalDetweenonsetanOtleatn
<br /> y�. IMMEDIATE CAUSE IENTER ONLY ONE CAUSE PER LINE FOR�a61b�,AND(c�) �
<br /> `"� C L•l d L�6�1��� c,A•c.Gr�v d�+1�d w�T�:l L��/EJ� 1il/U�Gy7��vT �
<br /> �
<br />� I�I � Imerval bet�vesn onsel and tleam
<br />� OUE TO.OR AS A CONSEWENCE OF� . i
<br /> i
<br /> i
<br />' IM I Irnerval bBh+eBn Onsel arW Oeath
<br /> DUE T0.OR AS A CONSEOUENCE OF: i
<br /> i r
<br /> I
<br /> �e� 1
<br /> PA�OTHER SIGNIFICANT CONDITIONS-CaMilions contribulin9 b the AeeM Oul^a re�a�ed PART III IF FEMALE.WAS THEHE A � 2a AUTOPSV 25 EX M NER OR ORONER MEDICAL
<br /> PREGNANCY IN THE PAST 3 MONTHS �6
<br /> II �Ages�0-5<) Ves No Ves No Ves No I
<br /> � 26D.DATE OF IWURY (Mo..Day.Yi.l �-HWR OF INJURV 26tl.DESGRIBE HOW INJURY OCCURRED �-
<br /> � AccWe�t � UnCelermineC M f
<br /> � �itle � pentliny 28e.INJURV AT WORK 26L�PLAe E Q�F,�I�J�U�fl�%!�`h�.!�.�arm.street�actory 26g.LOCATION STREET OR H.f.D.NO. CI7V Oii TOWN STA7E
<br /> Ific bu ��l%
<br /> � Hortucide imes�gation res� No�
<br /> 27a.OATE OF DEATH /MO.Day.n.) 2Ba.DATE SIGNED /MO..Day.Yc! 28b.TIME OF DEATH
<br /> /�- .�/- i'� t<w M
<br /> a� y�
<br /> �, 27b.DA7E SIGNED /MO..Day.Yr.) 27c.7IME OF DEATH
<br /> �6`y 28c.PRONWNCED DEAD /MO.Oay.Ycl 2BE.PRONOUNCED DEAD /hburl
<br /> ���5 �- aZ�_� / �•��-G) /� M �¢�€ M
<br /> E� gw�
<br /> 27A.To tl�e De�l d my kiwwb098 acwr time.Eale de�e��b� °�� ���"��'$d examinaGOn andior nvesagatbn,in my oqnion death occurrotl at
<br /> causelsl swted. ~° a tl+e time,dare anA pace an0 due w Me causels�stateC.
<br /> ( � nxe antl Title �naWre an0 Tille
<br /> 2i.dD TOBACCO USE CONTRIB TO THE DEATH? 30a HAS ORGAN OR TISSUE OONATION BEEN CONSIDERED? 30.D WAS CANSENT GRANTED? .
<br />� � VES NO � UNKNOWN � YES � �.NO � VES � NO
<br />. �f.NAME ANO ADORESS OF CERTIf1ER(PHVSICIAN,CORONER'S PHYSICIAN OR CWNTV ATTORNEVI /Ty{�e a Prinll
<br />� pr. I�obext Jr. M.D. 8303 St. Omaha NE 68114
<br /> d ..._ �.,.�,� � � _ . _L- -- n .� 3�e.D�TE FlIEO er AEOISrnM pwv..u�r.vcl
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