Laserfiche WebLink
WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES <br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTCS-SECWM,, WHICH IS <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />D T F S <br />200509130 ��� ASSISTANT STATE-REGISTRAR <br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICESS SYSTEM <br />STATE OF N99AAW — DEPAWWNT Of *WkTIf - <br />aulr 0 OF VITAL ST•ATiS3T' S <br />_.12151 <br />CERT'IFICA. E OF DEATH <br />q T WNXILE LA6T � 7 SE %_•,�.•�.••_ OW Yi—w <br />Lydis (NM murrray Fable (letober M,19�9! <br />DF lM171i NrAelkkSA. nlAwmwY! Ss APE -LrM �>fl6slr tMIpE911 VFJiR �MOW;QAY 4DATE OF W1t�vow <br />jYn.l , sn YPS i BAYS $ c HtxMia' February 05, 1917 <br />. INM�[6T !f PLACE OFOFAT14 <br />AIO6PRAL ® pTeIEN ® WnJry HgrAr <br />-Ileew �AlfIAIOM1 Qw/1e9eeedM/kenbA'� ❑ EH Ow"ft6 ❑� . <br />:SL F"00"Wical Cellar <br />LOS, 6d L7Tr1#o9T6 Be. MOM OF MAIN <br />YW { Ne ❑ Han <br />IL R9390= STALTE 6a cckwrr 4. CrtI. TDWNOR LOCATYOPt M AND R 1C4dAi w L�e1fS <br />Has Grand .gland 11W Nft rtb T 3 VON Ne ❑ <br />hy,Y6Mle- NMH�Anrnew YwAeix m i* I 1w®YAMM 11 YY00WW 18 NAMEOFIFOM astir qwr mwaw iwi <br />=004M <br />A ® C7 Ne9 & <br />ltwelASlTaxa+» /ar aF Vae; A6 <br />:Ad�ln�truiar <br />'''}� +y FtifBT tr <br />NMIS DONA= EVER W US. AM" FORCwi <br />�Ir�s%pMMtk pITSA6�wars+ddMsWswNcecl <br />T� fANI➢iIiAIX1FIESS <br />is EDUCATION <br />19alryYryarbsbmtlu7 iW121 GMype r1rn5•r <br />IO0CDI9larY A !! L • <br />A pow MbOLE e1MtYAAE <br />Mxf1e Gi" <br />funeral Home El °d" ❑ °°" Grand hian!& Nebral►lm <br />ApFkRi58 ETLx+RFP.NO.PrTroRTOLrN,arA zE+i <br />?�.. TffiCArI$E IEN YONLCAuaR:£RLkEFORIdIlnP.AeWMi! I sssnsisnrranaewrn®arw <br />PAW � <br />PYE PR ASA � 1rR'rAlewwlAnaweeals oeAn _ <br />OUF TO-OR AS A CF' ids, l�r! rYK+dIIR <br />07TER ICdRMY CC TKIMS•CPYkww cpR81R14gMw peMry blA not n161/d <br />PART FGkANCEWLE WAS THEREA 21 AilTOFSY 19. MMSCAEFAIEc,"Mar F-01Gil <br />/AqY PREGNANCY I!i THE PASY 9 Mpt(rN9T - E)iAkMiEfi OR CDRONEI+r <br />■ <br />_ mw *sc Yi6 <br />NO Yes W Y116 1k <br />26A _ 26b DATE OF P4AMh' 0&.D* YrJ 26c t" OF Ni M 26d <br />11ri6 DESCNHE HOW 116N1RY OCCURIIEO <br />❑ AceA1Fe ❑ W.." y _ <br />❑ SuoMe ❑ P/ i'r2 No. MWAY AT Wt%I1t 261. cqq! bMkorkiMYJ T �d rlrb�e. Mm. atael. r1AC�Y 164. LOCATION SIREET OR RF.R ND. My OR MWN STATE <br />❑ 1IpnIC1tlA MvaWgee(.r YAe ❑ ND 9 x'91 <br />27& GATE OF MM ft, IVY YcJ 2%, DAn 6 WIED IW. 00 rrl 200. nm OF OBATH <br />27b DATE SKiMED fW- OW1.. Yr) 127c TIME OF DEATH + „ 26c P"".O"D DEAD Ab, Ow W; aft PRONO1NKkO Dem MAwr <br />-0415 too. I <br />at r <br />R7d.To616be&SlnWklluY*OdR*M Y YrtMI.MM eMCAwMdw10 216.On616EiWd*mbTw nand• arYM11ly6 Kin,Yeabrapwmtled�axcwlMM <br />cwwsisoda Orr ( y�; �� a swMnk�owAndPg "and dueA76wenosmewsas _ <br />29. tM0 TOQJISxtD usE r.ONtil6}1 +7E TO a TM7 HAS iXlrilVi tIR T1Frfi41F DONATPPN ®Ek'N CONONMa ED7 90.b WAS.Vk8 T GRANTED' <br />❑ YE¢ WO IMMtNOWN YES - '76�r� -. -- ❑ m 2-1* <br />1* <br />21.NAMEAWADOW�$5CFCE Iii' NY8KAAK CDRDNEf4'SPWMMNORCOrMMATTOm /EY 11 er PrMY <br />Dr. A.E. Van Wit, 908 N. Howard Ave., Grand Island, �ie9rasAria 6=3 <br />72iF. aTiG16TRAR� � �-•�• •,•, —•. S2b. OATS FN.ED - - - <br />