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<br />The Southerly Forty -Four (44) feet of the Northerly Eighty -Eight (88) feet of Lots Four (4)
<br />and Five (5) in Block Fourteen (14) in Schimmer's Addition to the City of Grand Island,
<br />Nebraska, and being a rectangular tract having a westerly boundary line of Lot Four (4)
<br />in said Block, Hall County, Nebraska.
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<br />WHEN THIS COPY CRAMS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES ' L�
<br />SYSTEM, RCERTiFIES TFE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAnS=S ;WC7 _:WW_H IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE N
<br />ANLEY S. _COOPER
<br />OCT 17 2003 200313981 ASSISTAkf STATE REG?i$I*AR
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<br />LINCOLN, NEBRASKA HEALTH ANDIWAIAN SElfVIZ $SYSTEM
<br />0001"em"13er 4, 1992 STATE, OF MltMM -- DePAMMENT CW � =
<br />r- BtIEW OF VITAL STA TM
<br />CERTWICATE OF DEATH
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<br />L 10424
<br />I T E' - NAW
<br />�'. FIRST MIDDLE LAST �T2 5Ez 'j ATE :.T UFATN AI.1. LLr. rwr,
<br />Sylvanus John Happ Male September 29, 1982
<br />AND STATE OF BIRCH W no a U. S.A.. 4&r1 *m#*y,, So. AGE - Law -
<br />BitY Y :.t�AFA ; tMY,�{ 6 ! ATE �3F YM'TM :16- ow, viw
<br />71 (Yrs.l 5b. MOS DArS ) x 1101A1S kMZS
<br />Lindsey, Nebraska —7 ' Apr 9 21
<br />IVA SEC, WM NUMBER at PLACE OF DEATH
<br />HOSPITAL. klpWrn ❑ ER;OuK.++rse OC,A
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<br />) Ai�q' � Wrwrw +'ar�w :.'� Furow:,� a Otv �Sa:cwr
<br />FACILITY - NY" (Ind r+Idsd+t ;?A�r rnsl.Ind tkx tl�w/ OC. CITY, TOWN OR LOCATION OF DLATH j bt<. It54x CiTy'WT5 Ilk
<br />Op�C1'y OF DEAR,
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<br />Mpdie-al rant-. ,e Grand Island +. vow s v._11
<br />1 Nebraska ' Hall L Grand Island i 1708
<br />West nivirzinn
<br />10. RACE - 104, WNM. Bktk. Amer e= IrAw. 11. ANCESTRY jag- IIYw+. Lamm. German. Mc.) t2. MAPJ*D,NEVEA MARRIED,
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<br />ft'; (spo A —V
<br />s>I. f�AYE_ Allow
<br />, WIDOWED. (WORCEC (Bpooy/
<br />White German to Married
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<br />i ('►� !s lC�i I� y
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<br />11a, USUAL OCCUPATION raw krld of eat "W aff v ft-W 114b . RIND OF BUSINESS. INDUSTRY tr..
<br />d r 1A i rE"WomeryaSo0&.M,
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<br />Bartender stn Tavern X11
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<br />8th Grade
<br />14. FATHER - NAME I-PUT MIDDLE: LAST 117 MOTHER - MAIDEN NAME
<br />FIRST MCAXE IFT
<br />(de;.) _Edward Happ ' (dec.)
<br />Dorothy
<br />I i. WAS DECEADED EVER Ii U.S. ACHED FORCES? 1,. IiFOIRMAH? - NAME - 6^kJ 6 ADORE'S5
<br />!*'a, "0, a tnk) II q 0 ew WW 6elw CO WVip!)
<br />Yes Ii/3
<br />{fTREET OF A F �� NC. C!'Y 4F TO:YN�. STATE. �,
<br />;W -13- 43/10 -23 -45 ���Happ, 1708 W. Division, (rand Island, WE
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<br />2iu RAM. CM1116KRwNAWW, 2M DATE 200. MMETERY OR CREMATORY
<br />i NAYLE
<br />2Dd.:.DCATDN �', C"
<br />' B,ria1 _ 10/3/1992 Sacred Heart Cemetery
<br />g Greelley, t=F 63842
<br />? F. EM ' 9KINi1 JkCCf. i 113 r}' 22. FUNERAL HOME • NAME AND ADDRESS
<br />!STAEE7 OR R F.D. NO.. -My OR TOAW, STATE. Or:
<br />t! Finn & Sons
<br />Greele , hE 68342
<br />YS t !ENTER ONLY ONE CAUSE PER LIE FOR Ea). (N. AND (C))
<br />PnRT
<br />■r+111I I„MM aeM1 aola `�
<br />Ca est ve Cardiac Failure
<br />2 hours
<br />DUE TO. OR AS A COMuf3kiE.HCE Or
<br />b. -W -61 6eo�eae oaew a+I awne
<br />_ I Cardiac Valvular Disease
<br />1 hear
<br />IAIIE TO. OR AS A CONSE01. NCE OF!
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<br />+ryww tabea u1w1 aeI rM
<br />Coronary Artery Disease
<br />More than 5 years
<br />PART OT!!� CONDYf'fOM.B • COrldilblla 10 ftool xi rot rkliMA PART r. OF FEMALE. WAS THERE A
<br />; 24. At,TCPSY I2S. IMt CA.E AMPONFIEP 30 t#+71C11L
<br />I PREGNANCY ;N THE ?AST = MC: .:
<br />I Marc soma Prostate yr 0
<br />450SC4 Yr or Aky E %/M�8[ OR OORDkMR:
<br />*i �•'°'r "• «""NO
<br />No 0
<br />�2Y ALxiDie7[T. $tMCiC . HOMOC;IDc, L.#IDET.. 2SD. DATE OF Ii,MX:V �1uv..L1Ay. Yry 26C HOUR OF IUJRY 26d. DESCRIBE HOW N,WRY OCCUFfe -,
<br />OR PENW4 WVESTIGAT IO4 7.°FaCLy,1
<br />— • - ••• ' �wwrnn. ant�,aR/Sotedy)— vAky at (S� Fo wFU.Na IYGRT.AII+ &.�?_
<br />VIL DATE OF 06T—H ;'At, Dor 2ft DATE SIGNED /W, DW. Yr./ law ia,E OF DfzLTr
<br />September 29, 1992
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<br />270. DATE SRiNED E,b.. Dr /, Yri 1270. T*M OF DEATH 1 /AP ' _*_- } DEAD (4b_ .'."j.•. Yi I !2W PIS 00114V /iYk/
<br />October 3, 1992 10'15 i
<br />s rfa T3 Ir bka of oW knOeMYO,, oc Jrav preA aW ew a : ! 2e2. On w. aw oe,a «e ww we t mw+pUs o er w�... wr a..swt if w
<br />Ow».L., ,Ialkd. / �kr 4n�., Orc ,na p ee wm *" %,r raley,' kow
<br />and
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<br />010 YO&ACM use ONTFA TE TO NA$ ORQAN OR TMSUE DONATION MAI CONSR>vKW SOD. was 00~ 4IIIIMUO W
<br />I O YU qtNo O UNKNOWN 0 YES ENO 1} Ykd
<br />31. kLAME ANO ADOM" ("'Y$rM. CORCMWS PWS CN OR COUW Y ATTORNY) /Typo or Pm
<br />Bobby Abra a.D.JIA,&dical - -- - s 1
<br />Center, 2201 N. BroadwpIi_ r_Y9ra T.t air e y
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