|
200207078
<br />NHENTHIS COPYGRRIE4TIERAI3ED SEAL OF FHEHEBRASNAHESSUMAND HUMAN SEANCES
<br />SYSTEMIT CERTNIES IHE BELOW TO BEA TRUE COPY OF ME ORSMALPPCORD ON FILE WIN
<br />THE NEBRASKA HEALTHAND HUMAN SERNCES SYSTEM NTAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR NTAL RECORDS / ,T
<br />DATEOFISSUANCE
<br />JUN 81998 AN EYB °° °PER
<br />ASSISTANT STATE REGISTRAR
<br />DNCOULNEBRASKA HFALTHANOHUMANSERNCESSYSTEM
<br />STALEOFNEBREP IU OEPMTM1 @fIOFIffALTHANDNIMANSEAVICES "CEMDSI RT
<br />Amended June 9, 1998 CERTIFICATE OF DEATH 9 O II'�1 nn(]
<br />V V /
<br />t T " "`
<br />)itume Muriel Lvrsen
<br />Female
<br />January 14, 1998w _.._
<br />aI . "I- M ITT, II...sT.m. j
<br />.,44
<br />r. u,.. m.. ,.."
<br />oMarch
<br />oflz
<br />Grand Island Nebraska
<br />""
<br />19, 1953
<br />SONCIAL ISSUANCE
<br />'LATE
<br />®A..,. — ❑ NEENTERANA OTHEI
<br />❑ rwa."..A �. ❑ AWN"...
<br />�..... AA,A,oA.AWA..e...eC
<br />" ..
<br />Good Samaritan Hospital
<br />❑ "OA ❑ OJEW BERLIN
<br />N CITY o.,NOA.a "u.H
<br />NEURAL
<br />"Buffalo DU.
<br />Kearney
<br />N WLAW
<br />#Grand
<br />WAR RELAY
<br />Nebraska
<br />Island~
<br />1309E West Charles, 68801
<br />WE TD AN
<br />Nr AN ,.., ,.......NN...... 1� I
<br />"RNTL 14,'Wµ NEWUARAW..a.� �. �k�n
<br />. aED �. n
<br />.Jao< z.wN. A
<br />"eri
<br />La.,..e..,.,.,
<br />•A .... �.
<br />lUnINGE1111111HEY
<br />11
<br />"A^
<br />%s aEL cs[n�
<br />Public SchoolPe P'aN
<br />e�e`°` " " M,n.A. .,.
<br />FATHER NAME REAL .. "E
<br />F" DUST .AD,AE M.i "EN w"Wie
<br />Ballis
<br />Leona
<br />AN a
<br />w
<br />IF ENT rILmo AmnESS S$4 HO OR O1TOWN!TNE ZIP'
<br />1216 West Louise, Grand Island, Nebraska 68801
<br />WHY SJMr�,,RVWWANV
<br />sM�.
<br />EA
<br />.o
<br />0lllb11998on W ti Memorial Park Cm
<br />R
<br />"A OANTI
<br />j Ap- eufler- Geddes Funeral Home
<br />�],..�... [] ",ANNA. Grand Island, Nebraska
<br />"A HIIARAL 10"
<br />1123 West Second Grand Island, Nebraska, 68801 -5899
<br />23 WIFINIS 11119 EN r ER PH .
<br />AID T
<br />�ILICI (hr I
<br />I IN I ('TL Il r/ I r IIAC.E r 12 LISQ6yC:L
<br />M q��l
<br />'. I
<br />� ( %fi
<br />1 It
<br />l
<br />A.n...WAA.
<br />LAW 11 es.o 0Nrwu�a INAMIAVAWA
<br />o
<br />z.oT�,D "NVT°'DAEO,
<br />EAST ITIE
<br />ENERGY
<br />"
<br />"wa..
<br />". ow..N.�p
<br />INJURY [CORRECT
<br />"W:§F
<br />WE
<br />� "N °�.o. .., AWAY
<br />«.NON ON N.,ow- a'.aN,o.,N .,.I•,
<br />❑ NEAR,., � ,.. []•US j
<br />..
<br />"'�:;'ET
<br />D rem WAP IT +�
<br />—
<br />DATE SIGNED HART a, T,A
<br />,µ o, LEAK
<br />gg�
<br />n "A.r �D°
<br />=,. SUM
<br />Be ..DNDDNDEDOeAD ,.b. D,.
<br />ANON «N�,�wa.,�.,
<br />{e SIC
<br />?✓ ne
<br />WASS' 21. TI I WAR AN INEVERNI.. MI
<br />GNP OTIONSFUST ANITENTREAREENTIAMPRI
<br />Rio
<br />AN
<br />a'O
<br />D�DTs
<br />a
<br />N N
<br />..,«N.EOa�
<br />o [y
<br />ODnD�,.TDN ®N�a,a.ED.
<br />ES ®ND
<br />nGeorge SK` P5
<br />naska
<br />dDr.
<br />Bascom 3320 Ave e A Kearney 68847„
<br />Aj +aNNAN
<br />wremEDer zna�
<br />I HEREBY CERTIFY THAT THIS IS AN MACT PHOIC> -COPY OF THE ORIGINAL DEATH CERTIFICATE
<br />FILED WITH THE BUREAU OF VITAL STATISTICS IN LINCOLN, NEBRASKA.
<br />l L kG r /c
<br />ARFEL- BUTLER - GEDDES FUNERAL HOME
<br />"I Y..... - S. ae o N, e "Go
<br />n
<br />I NMflAMOND A OSKoA
<br />COMM Up Not !Elw
<br />CO DERS MEMO: �42�
<br />Reg. of Deeds
<br />
|