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<br />RECORDER: SWY4SEI /a 17 -9 -9; N%SE1 /a 17 -9 -9; N%NE1/a 17 -9 -9; WMNWl /, 11 -9 -10;
<br />SW1 /, 13 -9 -9; and S %SW1 /, 27 -9 -9, Hall County, Nebraska
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEA4 R CERTFES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD AN Eq EAWTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIST*f S *M*VN4 �S
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. -
<br />DATE OF ISSUANCE_- "
<br />200304031. _� O
<br />MAR 3 1 2003 - Q
<br />ASSISTANT �TATE REC>;RTRAR- •,,
<br />LINCOLN, NEBRASKA HEALTH AND HtIN/A�kSERVICESXS€Ell�
<br />0 3 i 2 8 2 rIl1;lIiltA.i` lcA - U,�PAR IMEIVT OF HEALTH
<br />sureau of vital stad"ies `-- 70 03214
<br />�
<br />. CERTIFICATE OF DEATH �, _ 1-5 $TAU Nl MURIM
<br />DECEASED —NAME FIRST MIDDLE LAST
<br />MAIIRVG ADDRESS (SMIT OR R.F.D. NO., Cm oR TOWN, STATI, III
<br />DATE OF DEATH 1 MOFIT", DAY, YEAR 1
<br />1. Ernest Max Lepin
<br />ISEX
<br />M
<br />March 31, 1970
<br />2
<br />,
<br />RACE WINK, 141010, AMHICAN INDIAN,
<br />AGE —LAST
<br />LIN *0 1 "AR
<br />UNplf L OAY DATE OF BIRTH (MONTH, DAY,
<br />COUNTY OF DEATH
<br />1 MOS.
<br />DAYS
<br />ETC. 1 S"CIPY 1
<br />White
<br />.IRTNDAY 1 YEA.•
<br />67
<br />HOYRe MW. RSAR I
<br />e.
<br />51
<br />k. I 1LTune 2 1902
<br />i,.. Hall
<br />CRY, TOWN, OR LOCATION OF DEATH
<br />INSID! cm LIMITS
<br />S/lCIFY "ES oft NO I
<br />HOSPITAL OR OTHER INST —N I IF NOT IN 111"111, GIVE STMlT AND NUMEN 1
<br />-
<br />rk Grand Island Nebraska
<br />& yes
<br />x St. Francis Hospital
<br />STATE OF BUM I IF NOT IN U.S.A., NAME
<br />CITIZEN OF WHAT COUNTRY
<br />MARRIED, NEVER MARRED,
<br />SURVIVL4IG SPOUSE 1It acct, Give AwIDeN "&"I
<br />COkkAMI
<br />E. Nebraska
<br />P. U.S.A.
<br />WIDOWED, DIVORCED I ewwv )
<br />is. Married
<br />Iii. Ethel Farabee
<br />SOCIAL SECURITY NUMBER
<br />USUAL OCCUPATION 4w"—KIND Of WORK DON! DURING MOST OF
<br />KIND OF BUSINESS OR INDUSTRY
<br />12. 50S•. 8-2229
<br />W0De1N0 top*, Mot If "UtID 1
<br />mRetail- Merchant
<br />mOwne -O erato
<br />RESIDENCE - -STATE
<br />COUNTY
<br />CRY, TOWN. OR LOCATION
<br />I"w" Cm LW)TS
<br />STREET AND WMISM
<br />IM. Nebraska
<br />bw Hall
<br />114C. Doni han eb ska
<br />ISMS" Yes OR No )
<br />ILA. yes
<br />14.. -
<br />M•T ,nvl niw— I�IA/HCTT MARW NIT MIDDLE
<br />3ASi
<br />,Is. Charles T elni n IA LT; 1 11-1 .s....�
<br />MMOMMNT— NAME — REIATIONSNIP M
<br />MAIIRVG ADDRESS (SMIT OR R.F.D. NO., Cm oR TOWN, STATI, III
<br />1211. Mrs. Ethel Le in wife 1
<br />117b. Nebraska
<br />PART 1. DEATH WAS CAUSED !Y: (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), AND (c)j
<br />EKArMATWM Of IM fODY AND /OR TIIF INi1STIGiTION, IN Mr-p►1N1pA, ..-
<br />OW" OCCUUM ON INS DAL! AND OUR TO TN1 CAUSSIST STATED.
<br />(TYPE CM PRINT)
<br />! Swwr I
<br />Iw. pur.14L.L i 24b. L;ecLar
<br />DATE IMONTH, DAY, NAtI FUNERAL HOME —NAME j
<br />2«. April 1 0 ±s•. A fel -Bu E
<br />E R— 'NATURE IS LLICENSq NO. RK
<br />� 36 �. _4 ✓� Z :i.S� tM.
<br />�,, ucw,n .._ - MONTH -�• r DAY�V vow YEAR Now
<br />M. M.
<br />iA (4 oeG T1 A S IMO14m,
<br />f 2h a
<br />NO. CITY OR TOWN STAN NIP
<br />Grand Island, Nebrzska 68801
<br />LOCATION CITY on Tow" STATE
<br />ItaT -V 211. Tr%ninhnn 1kiX.,,T.H42ir0
<br />CRESS ( STeeel Ot E.F.O. NO., CITY OR TOWN, J'A". I,,)
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