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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO _BpA,TRUE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE IYWR NT'OP HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAktEPOSITORY FORS <br />VITAL RECORDS. <br />D., <br />DATE OF ISSUANCE <br />JUL 1 NGI STANLEY .'C.�,SS��I/'LFCTtlR <br />LINCOLN, NEBRASKA BUREAU OF�V�ai> - SR'RTISTICS <br />200209322 <br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH 78 13805 <br />BUREAU OF VITAL STATISTICS <br />CERTIFICATE OF DEATH kI 1, ah <br />OICEOf Xr -NAM! e5r MI e m <br />Peroy Milton Erase Male Deoemoer 21 1978 <br />PACE -Ie -0. WId4, E1xL. Anokw OXO1NIDSICFNIf. NO Lan, Meeken, A.. -W NI UNDIR I YIN UN." "Ay A"OE SNrNrMU .'., <br />Ind:nn,.L �rsr•.ilZ1 c.,- nn..ws rsp.nryl rmd 69 s. D.rs "ours� LEANS.I Oct. 29, 1909 <br />A K'inl to 5. GBrILLBn Se. <br />CITY AND SIN f p.NIN (N ner in US.A.. <ITZFN O,WXATCOTNT.Y MARRIED.. EIMARERD, NAMfp5rW5f f1E.:X, piw n:aaen neo) <br />ne a nF 1 WIDOW [O. OIVOKID(S ifYl <br />e Merrick Countyp Ne. .. IISA ID. Married II. Frances Nolyneaux ) Kruse <br />SOCIAL SECURT NUMFER USUALpCVIATIORIC n—S1M eE.ed deo dvinp roN EINDp IVSME55pINW51W Coum"OR TREAT" <br />,a0 206 IS.. Retired welder al,. Construction I Hall <br />CITY. TOWN OR LOCATION Of GRAIN INNOE CIR LIMITS NOSI,TAL OR OTNIR INSTIiVT10N- Name(Nrollul111— En " Rr:x. b.. InryXnllSewihl <br />(,.•ilE 1—N.) pir. nna d. u.e6.•I <br />I,. Grand Island IM. Les IM. St krancis Hoe ital IA.. inpatient <br />R151OENCE -Sr." COVNT CITY. TOWN OR LOCATION STRFETIMO MUMEER INSIDI COr IIIMiS <br />ISpxi/YY.,r Na) <br />ISn. Nebraska III, Hall Ih. Grand Island Isa. 2 N. St. Paul Rd. m.. Yee <br />A M -NAM it MIDIXF —� I.ER- MAIDEN NU.1 I Sr MIOd <br />Fred Kruse I. Christie Washburn <br />WAS DECEASED EVER IN U.S. ALINED fOKESi INEORM1Nl- NAME- RFtAIIONSNII- M11LIN0 AWRE55 ryInO OI E.Lp. ND.. Clry ORreN�' ) <br />(Y., .n111N ,pn +. o.<namtlun.nl <br />Ie. No LP. Mrs. N7ancea Krase -wif N. St.Paul Hd. Grand IslESnd <br />LVRUL. Cn:rorinn. Ren:nwl A CfMflfRYd<RF/MIOK -NAME LOGEIN)N C1IYOR TOWN SIATF <br />mn. Burial wl.. 12 26 8 ]a. Westlawn Memorial Park ]Da, Grand Island NE <br />1MfR- ITWF .CEN O S NNERR mOWf -NUAE .NO AOMESS I.—OS L.D.— O,,.TOWN. 51Y1, [Ip 6BBGl <br />sx / ],.Livi ston- So ndermasn's 0 W,Koenig, Grand Island Ne. <br />aw Sx,M.I L,.M.e.n e..W -• x„x .sN.. ..a a.. wa- ° N.. a.:. �w. I� ..:w�.'x:'�"°...wo.�l".I�'I`•n e..W .....r. <br />y3- <br />yC ]H <br />DN SIONF MO.. De <br />.M �w.. eM l.x.l� N r. SRIEST�- <br />D.11 11.) 2 <br />].e <br />1? M <br />ATF OF DEATN(.' Oq. Yr.l j � PPONOVMCEOOfAD rRDNOUXCfDDEADINaurl <br />NAM! AND ADDR <br />OR CERTIFIER IPNY 1 11M, CORONER'S IIIr51CIAN OUMR AROPNFR IIYp.O• I•iM) <br />23 A. FIT ,.Wig M D 7l7 Weei An —. t 1 eclrvfD eY qRem�xR�RR IMn., DaY. r..) <br />REWSrRAR <br />IdRTE GU$y'; IFNIER Nlr CAUSl ILK INK fOR (ol. 1, ANO (.)) nma Yw.w --IVN 0..X: <br />'r l.�T�. i'a dS d cl N <br />Ivl wm euw.M a..:l <br />WEIO. OR ACONSEOUENCF OE: <br />IFI wm, Sww.n uw sna a..:lr <br />WE TO, OR N R CONSEOUFNCE p: <br />d <br />SE LW ESI iI CONMNM <br />S .-< IM.n••.nMS 'Ain NaMYnI ..�n -NOrdV.S M Or IWPAYn .r .l i "i.e. OA[V[lY omm O <br />]vLuA <br />GN µconpNIn O <br />MFWn, <br />'AFT NANCI.dS iAil D . y"a <br />T. ❑ Se. n <br />ACCIOIM.NRCNEMMI. "KERNS MIVn <br />SERI. <br />r SIR, ]dl. <br />u - ww <br />SCI- FEW IA—`AI <br />IOCMpN SiEIRpR.1.0. K. CIIYpIOWN SiAfE <br />