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RE: Undivided one -half (1/2) interest in Lot Eighteen (18), Argo 4th
<br />Subdivision, Village of Alda, Hall County, Nebraska.
<br />WHEN THIS COPYCARRES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUM" SERVICES
<br />SYSTEM, R CERTIRES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL � ON FLEE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATI$1ICS SEE - WtfIEH 1S
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE -
<br />p �$. COOPER
<br />JAN
<br />LINCOLN, EBRAOSKA HEALTH ANd RUMAN SER E84YSTEM
<br />200212289
<br />STATE OF NENUAS" — DUAK"IE f Of NMTH WAL STA
<br />sUMAU or TIS
<br />9 7 097102
<br />TICS
<br />CERTIFICATE OF DEATH
<br />, NAIE F,I,S: LROm Lw I SEX ? DATE OF DEATH AAPw ONY v@"
<br />1
<br />Archie Ernest Price Male August 26, 1997
<br />t AIL FATE a Bf1TH RANI ar USA. rsl�CO~ 5• AGE • Low SPFIANF UNOE/U f YEAR UNDER T pAr l DATE OF BATH At, r Dry YFAy
<br />McCcok, Nebraska 50 7 ,4os ' a�K MMS June 9, 1947
<br />7. SOCAI S�tMEIT 14A�T w PEACE OF DEATH
<br />N,OSWAL ❑ m-w 1THEH ED ,IIPNAI, I,NrII,
<br />507 -54 -3356 ❑ fA1)1�Pr, ® PASft ,
<br />E', �AtXIT ►•H�A I�nvwF,dliN l�Mwtl w/�OF7
<br />❑ DOA Q DowISCW4.
<br />18 Venus _-
<br />Be C" TOM OR LOCATION CF DEATH b NSIDE CRY EYES EP COUNTY OF DEATH
<br />Alda Y" 11 N. ® Hall
<br />PESIOHA;E •STATE • Q::.AIY t CRY. TOIIIN OR LOCATION EF STREET AND NUMBER Aw—V m CRAII w ASIDE CRY OATS
<br />Nebrarka Hall Alda 18 Venus 68810 •� ❑
<br />- --
<br />NK.E • I.�. wI1AA arrA. APrew I,e.rL ,,. ANCESTRY N;. AIArL MPSSL cS.P.L+u ,: MARRED ❑WIDOW® 13 NA4E a►DUSE If .r pI. PM.AP, rlrlw
<br />White apsoH American Diane Potrzeba
<br />Ift WUKOOUPATION ITA.P /wlry�oAYrtLN,7 wa,1 QpT ,t RPO OF BU7N1Ae" M0"llwy ,5 EOUCATION ISO�PIiII R'*NA17,pNCpIPNUA
<br />0 -in CIUOS•i
<br />IRVMBt~#AMN,q Dv EMwvri4ArY O>0 dH„
<br />1
<br />Laborer Packing House
<br />N FATHEM -MAIZE FPO mom UST ,7
<br />MOTHER FRST MIIIOLE MAC" WOOL"
<br />Jose h Harr Price I
<br />Mary Ann Matson_ -
<br />14 WAS OfCfABEO EVER M US ARMED FQIICEST
<br />,fM MFORNMNT - ,IIM,E
<br />TYP.neww*3 aYP,PMwARF do" a,
<br />No
<br />Diane Price
<br />-
<br />,Et BIpWANT MALL ADd1ESS ISTREET OR RFD MO. CITY OR TOWN STATE DPI
<br />18 Venus Alda, Nebraska 68810
<br />X EM&%JAER- SIGNATURE i LICHEE NO 21A METHODOFWWOW *h 21R DATE 21c CCMEYER,'OR CREMATORY NAME
<br />Not embalmed ❑B r ❑R,r.IP.r Must 7, 199 Central Ne. Cremation Ser_v:
<br />�—
<br />aL FUA'IEIEAL HOME -NAME 7/L CEMETV" DR CREMATORY LOCATION CITY CM TOWN STATE
<br />:.ivingston- Sondermann F.H. IN— ❑°e"'° Gibbon, Nebraska_
<br />m tMERAl1,01NE ADDRESS ISTREEI OR RF.D. NO CRY OR TOWN. STATE DPI
<br />601 N. Webb Road, Grand Island, Ne. 68803 -4050
<br />n AAA MUTE CAUSE IEI1'. C r :.NLY DHE GWSE PER Led" to ft AND K4
<br />'unknown
<br />t'PA,,, Cardiopulmonary failure
<br />D'.E TO. OR AS •!ANSfOUENCE OF i N+,r.r �'' w ��
<br />a CVA 2 months
<br />botiA
<br />D TO. AS A CONSEOUENCE OF 'QM� a4
<br />UE
<br />p
<br />�OTHERSXPWVIVT- A)ND1TION$- CW"e"oo meet* a4owna nN,w � PAWTRE1ENALE WAS T//EREA :_, ADTOPSY 2S WAS CASE REFERRED TO UIEpCN.
<br />PREGNANCY M TNf PACT ] MONTHS' I Ek:.LRNER O7R CORLP,ER'+
<br />,diabetes RA,A 10.541 YN N, YA Nt
<br />M 'DATE OF INJURY pAI. DAY. IYI
<br />2!e HOU%Or PQURY
<br />26a DESCRISE
<br />HOW MJUAY OCCURRED
<br />AcpOP� � UPIO,IPA.I,O
<br />Y
<br />IBA MJNY AT WORK
<br />%CWy C
<br />Su[p P,ra"
<br />-A'9 LOCATION STAtET OR R F D NO CITY OR TOW.T+ STATE
<br />Hp wwe k-1wowt,
<br />Y„ ❑ „P ❑
<br />as
<br />120
<br />--
<br />—
<br />2N DATE SIGNED /Ab DPY Y• l 2,b TAE OF DEATH
<br />Nuqust
<br />27A GATE OF DEATH Mb DAY 171
<br />s !
<br />23, 1997 10:00 a M_
<br />2BC PRONOUNCED D: RD rAb Dw Y11 2ft PNONOU/NCED OFAD I.—
<br />1 27b DATE SIGNED *0 DAY Yrl 27c TIME OF DEATH
<br />M
<br />a H9
<br />Au ust 26 1997 10:55 a �•
<br />2B, Or. FH bAAO a PWI.rWOn w,Iq ,pn.Y1 a.,o «one M
<br />tiACP � ,r .NNO
<br />a
<br />270 Tow* bAr a ni, v.,rbopP a,AR oceln40 r h rlv. tNM nP u,NCP &,110- b eI, 3
<br />tort Q3 Of
<br />20A HA$ ORGAN OR TISSUE DON aTIDN BEEN
<br />CONSIDERED, J�OD/WAS GJN. GAN•T i0l
<br />b OIO T11ff0--8--A1111CCO USE CONTW1B11TE TO TI,E OEA r:R'
<br />(T
<br />—
<br />V YES ❑ NO ® UFACNOWN X- ❑ YES ®
<br />NO I '1 l_�
<br />31 NAME AND A'ORE$$Oi CF.RTRIFA IPNYSIC MN. CWiONERSPMY $ICANU.7000NT'ATTORNEYi �TypPp Rte'
<br />X'Ellen L. Totzke, HCA PO fox 367, rand Island, Nebraska 68802
<br />X!, REGISTRAR �`. � -- - - -- - SUP 3.1997 _
<br />.r
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