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WHEN TWSCOPYCA y,ES TFE RAISED SEAL of THE NEBRASKA HEALTHAND HUM— MSEIMCES
<br />SYSTE,A IT CERTFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REC4101V'OWFaE WITH
<br />THE NEBRASKA HEALTH AND HIIAAN SERVICES SYSTEM WTAL STATISTIC¢SECTIOIT/.ijOWH'ICH IS
<br />THE LEGAL DEPOSITORY FOR WTAL RECOROA
<br />D FEB 14 2003 200302231
<br />aXRf�DOPEa
<br />asslanNtsTarEIrEGIS7RgIF -
<br />LINCOLN, NEBRASKA _ HEALTHANO HLMAM,3ERNCES MTM -
<br />STATE OF NEEAASAA -ATA TMENT OF NEALT:7 " -
<br />DUREADOFWTALSTATISTICS 87 10567
<br />Amended November 18, 1957 CERTIFIC£TE OF DEATH-
<br />1
<br />William Elmer Imlay Male September 16, 1987
<br />MCf -Nf.W INb.I iYxWntlN)INIwHfNrbf.. NDlian. N..kan. ♦Gf'4NnYV. .aUNw \I YFAf ♦r Wif Or ElfrMIW., Mp21
<br />/romr..N'16f�5°Tce =can
<br />At, Iv.. 59 was wrsi xows. Nlln: January 7. 1928
<br />It"ifY VIN er Na y;., Irr.N Ued --NN) '�.._
<br />Crnnd TMl znd yea . St. Francis Medical Center 1 DOA
<br />\IL04NC1- VATI COUNM1
<br />]s.. Nebraska !a. Hall
<br />CI"M It.♦IION
<br />]x. Grand Island
<br />S'IEI ♦ND NUNENI
<br />ISd. 3015 Gladstone Cir.
<br />wfIOECT SWIS
<br />!Sp„il rwsllN
<br />I V,
<br />NE\ -MIA N f I i
<br />William Henr Im18
<br />11
<br />Clara Mae Ullstrom
<br />IN" wC6VlD
<br />tta.. wwU
<br />u. Yes
<br />IN U. S. OMID I.111
<br />llr
<br />IRS -22 3177- *1f153
<br />I N.NT- NAMf- ULAIMANfIl- MU]INO AD0.04 IS:IIN IN E.ED. ND. Cm IN IONIrMaw
<br />(,.Ethel Imla Wife 3015 Gladstone Cir. Grand Island N
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<br />CWllfrvw QEMAfOb -NAME LOCATION CITY wIOWN WATT
<br />sD..Burial
<br />—Se t. 19 1987
<br />]DlGrand Island City Cemetery »d. Grand Island Nebraska
<br />1M! \- AlV \F E VCENSE NQ.
<br />FUNIFAL MOMF -NAMF ♦Nn yfff55 :O:::L V,::. D..N. OnM NwF EEYL NIl 68801
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<br />WHEN TWSCOPYCA y,ES TFE RAISED SEAL of THE NEBRASKA HEALTHAND HUM— MSEIMCES
<br />SYSTE,A IT CERTFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REC4101V'OWFaE WITH
<br />THE NEBRASKA HEALTH AND HIIAAN SERVICES SYSTEM WTAL STATISTIC¢SECTIOIT/.ijOWH'ICH IS
<br />THE LEGAL DEPOSITORY FOR WTAL RECOROA
<br />D FEB 14 2003 200302231
<br />aXRf�DOPEa
<br />asslanNtsTarEIrEGIS7RgIF -
<br />LINCOLN, NEBRASKA _ HEALTHANO HLMAM,3ERNCES MTM -
<br />STATE OF NEEAASAA -ATA TMENT OF NEALT:7 " -
<br />DUREADOFWTALSTATISTICS 87 10567
<br />Amended November 18, 1957 CERTIFIC£TE OF DEATH-
<br />1
<br />William Elmer Imlay Male September 16, 1987
<br />MCf -Nf.W INb.I iYxWntlN)INIwHfNrbf.. NDlian. N..kan. ♦Gf'4NnYV. .aUNw \I YFAf ♦r Wif Or ElfrMIW., Mp21
<br />/romr..N'16f�5°Tce =can
<br />At, Iv.. 59 was wrsi xows. Nlln: January 7. 1928
<br />It"ifY VIN er Na y;., Irr.N Ued --NN) '�.._
<br />Crnnd TMl znd yea . St. Francis Medical Center 1 DOA
<br />\IL04NC1- VATI COUNM1
<br />]s.. Nebraska !a. Hall
<br />CI"M It.♦IION
<br />]x. Grand Island
<br />S'IEI ♦ND NUNENI
<br />ISd. 3015 Gladstone Cir.
<br />wfIOECT SWIS
<br />!Sp„il rwsllN
<br />I V,
<br />NE\ -MIA N f I i
<br />William Henr Im18
<br />11
<br />Clara Mae Ullstrom
<br />IN" wC6VlD
<br />tta.. wwU
<br />u. Yes
<br />IN U. S. OMID I.111
<br />llr
<br />IRS -22 3177- *1f153
<br />I N.NT- NAMf- ULAIMANfIl- MU]INO AD0.04 IS:IIN IN E.ED. ND. Cm IN IONIrMaw
<br />(,.Ethel Imla Wife 3015 Gladstone Cir. Grand Island N
<br />1Utl14 CnlnNen, 4wNe1
<br />j4� ++Yn.n+R
<br />CWllfrvw QEMAfOb -NAME LOCATION CITY wIOWN WATT
<br />sD..Burial
<br />—Se t. 19 1987
<br />]DlGrand Island City Cemetery »d. Grand Island Nebraska
<br />1M! \- AlV \F E VCENSE NQ.
<br />FUNIFAL MOMF -NAMF ♦Nn yfff55 :O:::L V,::. D..N. OnM NwF EEYL NIl 68801
<br />]L
<br />]llivin ston- Sondermann 505 West KoeniS, Grand Island, N
<br />♦
<br />`Ln ^� \ \y, /✓Y
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