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m C"> cf) <br />C: M tA <br />z <br />M <br />M > f-P <br />CD <br />Q. _N1 CJ0 _q <br />C13 <br />0 2 <br />-c E3 <br />co CD <br />Cn z <br />—,3 <br />(n <br />. C' <br />RE: Lot Two (2) of Dahlke Subdivision in the City of Grand Island, Hall County, Nebraska. <br />Lot Sixteen (16), Block Two (2), Continental Gardens Addition to the City of Grand Island, Hall <br />County, Nebraska. <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES <br />SYSTEM, IT CERTFES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOMwON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS Is <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />DATE OF ISSUANCE <br />NOV 2 2 2004 <br />LINCOLN, NEBRASKA <br />2000148( HEALTH, <br />STATE OF NEBRASKA — DEPAPTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS <br />7 73 4 2 <br />:0 <br />CERTIFICATE OF DEATH 6 — <br />_-CE---- FIRST MIDDLE LAST <br />2 SEX <br />3 DATE OF OEATm :mmm up, yw) <br />Gordon Everett Dahlke <br />Male <br />June 03, 1"6 <br />hCITY ANDSYATEOFBIRTH eNr4ln USA naarcoymy) Sa AGE • LM %Wdav UNDER I YEAR ' <br />UNDER, DAY 6 DATE OF ORT64 Akno, I),, <br />lyrs; 5b "Os DAYS <br />Cairo Nebraska 76 <br />Sc <br />January 27,1920 <br />7 SOCIAL SECURTTV NUMBER 84 PLACE OF DEDEATH AT <br />" <br />508-10-2652 HOVITAL 1:1 W011"m 0 H� <br />"--. <br />', 0 <br />a FACILITY - rMIMIIk -7 . en >Anw P-.O.rlmo <br />16 Via Como L_j DOA <br />bc CITY TOWN OR LOCATION OF OFAT14 I ed I;"—M CITY LIMITS ft COLMY Lif MATH <br />Grand Island i .[R-O! Hall <br />9& RESIDENCE - STATE ab COUNTY 9C CITY T')WNORLOCATION ANDWAIRIER (#Wk&'V2;- •S <br />Nebraska Hall Grand Isla" 16 Via Como, 69803 YIN <br />10 RACE • mg. Whft &ACk A"WCAP NOW, !'I ANCESTRY mg. WAR M"CAlt G&WdM •0 <br />12 WIRRIED WIDOWED <br />3 NAME OF SPOUSE e0-*gWM000�M-W <br />NEVER DIVORCED <br />1 MARRIED <br />I' Mildred Barrett <br />141 USUAL OCCUPATION rOrra JalOn aLYa WfIMPaag eM6t 1'4b KMOFSUSWESSINOUSTRY <br />115 EDUCATION fS4W##nW_r- <br />o7wiftv M" awl "ffkwi <br />Owner/Operator 0 Sanitation Service '410 <br />I <br />It FATHER -NAME FIRST mom LAST <br />17 MOTHER FIRST MIDDLE MAIDEN SURNAME <br />Ono Dahlke I <br />Hortense Johnson <br />IS. WAS DECEASED <br />EVER IN US ARMED FORCES? <br />199. INFORMANT -NAME <br />JY$&ncorNMI( <br />Yes <br />I World War 11 10/14/1945 <br />Mildred Dabike <br />Ift. INFORMANT MAKMADDRESS (STREET OR RF.D NO. CITY OR TOWN STATE. ZPj <br />6 in Como, Grand Island, Nebraska 68803 <br />20 PABADAER - SKINATURE A LICENSE NO To METHOD OFDISPDSITM <br />21b DATE <br />216 CEMETERY ON U*_MA7OAV NAME <br />R... <br />06/07/19% <br />Westlawn MemorW Park Cemetery <br />FUNERAL HQ <br />210 CEMETERY OR CRBMTORY LOCATION CITY OR 'OVA STATE <br />A04-Butler-Geddes Funeral Home Q C..w Q Dr. <br />I Grand Island. Nebraska <br />= FUNERAL NOW ADOFE53 ISTMET CA Wo Mo.. CITY OR Tow STATE aM <br />1123 West Second Grand Island, Nebraska, 69901-58" <br />23 IMMEDIATE CAU K IE4TER ONLY ONE CAUSE PER LINE FOR mI u AND ICI PART <br />I IN <br />ACQ%56QU1MCEOF "A' <br />T <br />C -ro <br />66 r ojoirl c "_t I'M Pig <br />DUE TO OR AS A CONSEOLIENCE m; <br />(0 <br />OTHER SKINIFCANT CONDITIONS Cqpmw%cw*ft"j0ft <br />PART w iW;QU_ T—PA-RT IF FEMME WAS THERE A 124 AUTOPSY <br />-REGNANCY IN THE 'AV 3 MONIVAI IR Cf)%_NEPI <br />jAq. !0-5.1 .1. El N. ". F1 - 0 1 Y. <br />M DATE OF HOUR OF INJURY 26d. DESCRIBE HOW NJURVOCCURRED <br />❑ A=** ❑ uno.l.mYMO i M <br />❑ S.Cd' 'r-1 ps" 29f. PLACE OF pw %My 2% LOCATION STREET OR P F.D. NO CITY OR 7011% STATE <br />21a DATE OFOE- ,!4, Day Yr.) 26. DATE SKINED !MO Day Y,; TIME OF DEATH <br />126p <br />6 I i I <br />M <br />M DATA 3 Mk PRONOUNCED DEAD Ak Dek. Y,1 1280 PRONOUNCED DEAD 1* - Day Y, 2ft TIME OF DEATH <br />_ 11 S11 <br />f — <br />? 1/ <br />to '41 M <br />2 <br />270 To ft bW Of II knOW141fte " =w?*d M ft ow. 4"Arw DPM dU@ to ft 2 ofetwomwa-dor 100@010 nflV0PW d8WG=~*t <br />Ckdm'., To "V do* W4 04= Wd am to to mums) sow <br />U <br />pgMaval'"p, AMMENT <br />A OD Irrh USE CONTRIBUTE TOTMWMTNT 30A HAS OFM <br />b WAS CONSENT 0PANTEr" <br />YES NO 0 UNKNOWN x Yes <br />--NAKA—N6AMMSSOFCEM*�OMWiSOWcomommSMWWMOIRCOUWYATTOM <br />YES ONO <br />31 W I (7*@WftM <br />Dr. James OmeL 2116 W. Falfey Ave. Suite rand Island, Nebraksa 68803 <br />I— ------ —, I — _­­ — f­y -11 <br />f <br />