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()U'I <br />G ~ ,,:J: <br />~ <br />s <br /> <br /> <br />CJ <br /> <br /> <br />Lot Fifteen (15)~ and the South Eight Feet (S 8') of Lot Thirteen <br />(13), in Block ~1ghteen (18), in University Place, ~" cdJition <br />to the Ci t-,: c" rand Island, Hall County, Ne'oras;,a <br /> <br />WHEN THIS copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES <br />SYSTEM, "CERT1FIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECPB.ll,,-QI!-flLE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA TIST1~CJlI;Wfj!9H IS <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. M~~J""'a~- <br />DATE OF ISSUANCE ~i~.i '- _uilt <br />NOV 0 7 2005 20051108 0 A~'STANtitAY,-_ ' -. ~ <br />LINCOLN, NEBRASKA HEALTHAND;HUMANSEIfII1J - .,;~ <br />"::" --_ f1....:....~ _~ <br /> <br />. - ~:, <br /> <br />STAU Of HEBlASKA. DEPAIlTMENT OF HEAL11f AM> HUMAN SERVICES FINANCE AM> SUPPORT <br /> <br />CERTI~~A~~~~EATH 04 0-7-921 <br />~ <br /> <br />I , DE:(c:OElln - ~ <br /> <br />FtRST <br /> <br />MoOOI-f <br /> <br />" !:lEX <br /> <br />~I'3DII.H OF OEAlH 4ftitlltl O~4t .,.."J <br />! <br /> <br />2004 <br /> <br />Male <br /> <br /> <br />Prederic:k <br />.. err", ~P;lOST~TEOFe.RtH ill't(lt.-.USI, "..~J <br /> <br /> <br />ON.U4'S.I~"'(j~ <br />[i) fWa..ae;.,(;~ <br /> <br />o <)0-,0, ,S/>K'" <br /> <br />UNOfR,10AV <br />,;c: HOURS "'''5 <br /> <br />uN , VEAR <br />50 MOS \ ~..s <br /> <br />4, <br /> <br />1918 <br /> <br />Ball Count , Nebraska <br />1 SOCIo\L SECu~1lY rttuuaSR <br />507-18-3703 <br /> <br />80 PLACE Of OEATH <br />~ITJ.h 0.- <br />o ER 0IIl*0nI <br />o OOA <br /> <br />'2!~EA <br /> <br />II> ACILITY ._ <br />2608 waugh st. <br /> <br />"""'-...-""'~ <br /> <br /> <br />80 '''SlOE CITY lIMITS <br /> <br />8C C'T> TOIIII\IOR LOC"TIONOF llEATH <br />Grand Island <br /> <br />Ball <br /> <br />lid STREET ANO NUMBER ,I""_Z",C_' <br /> <br />, 9< '''SlOE CITY L...TS <br /> <br />v.. 00 No 0 <br /> <br />... RESIOENC!'. $lA'E <br /> <br />!lI> co...rv <br /> <br />Nebraska <br /> <br />13 "AlAEOFSPO\ISE ....... ___I <br /> <br />'to ~ACE. I. g.. 'M'IIIt &lac" "''''''lIClt! ft)AI"I <br /> <br />OICI'S-.... white <br /> <br />,.. uSUAL OCCuPATION .(WW.....,--_- <br />dM)'lllI/l1fJ.,.,..,,;J~1 . <br />straddle "l'r\lck Driver <br />16 FATHER.I\LWE FIRST MIDDLE <br /> <br />1'6 EOIICATION ,Spec'''' "", _0'''' <...-, <br />EIemi""'VOt' SecQnCiaf'y IO,~2) ~ :1.':;,)":-" <br />, <br /> <br />FIt::cS1 <br /> <br />tJlIODl-E MAlot:.... ~uRNIJ.E <br /> <br />Clara <br /> <br />B8IIIUUl <br /> <br />willima <br /> <br />18 WAS oeCEASEO EvER'" uS _0 FOACES' <br />IV... 1"\0 tJ6l#*1 I"yft 9W1t.._~~~ <br />No <br /> <br />Elsie Knefelkaap <br /> <br />,... 'NFQRMANT <br /> <br />_INClAOORESS <br /> <br />ISTRI:ETORR <br /> <br />68803 <br /> <br />2'c CEMETERY OftCFl[:MA1(\FiY NAtIE <br /> <br />0-"," JUly 16, 2004 westlaIP ~Al J.l8Jk 0 '~y <br />21. CEllETERVORCRE.....TORVLOCAT'ON (:IT' OR TOWN SUTf <br /> <br />All paiths <br />22b FUNEIW. t<OME ADDRESS <br /> <br />Grand Island, Nebraska <br /> <br />2929 S. Locust <br />23 IUIoIECOATE CAU';E <br />p~ NA'lURAL CAUSES <br />10' <br />0lJE TO. OR AS A CON5IiOUfI<<ll! <br /> <br />st.. Grand Island, Nebraska <br />jENTER ()t4V QhIE CAUSE PEs:t LtNE FOR 'BI lbl. AfIIO ~ll <br /> <br />trwrv-i11 ~ 0Net .-,c .jI!o.... <br />UR<lIl\N <br /> <br />1I'4et\l.I~onMi"Iltl'II':\li!'dt'" <br /> <br />Ibl <br />DUE TO. OR AS A CONSE ...cE <br /> <br />.,..,W'al~~.~,~~ <br /> <br />"" <br /> <br /> <br />I.' <br />PART 0_" SlGNl'ICNIT CONll"oONS. --~ .....-......- <br />. <br /> <br />_ l),l'rE OF IIII.lURV 1110 0... Y'./ Rc HOIlA OF ItIIJURV <br /> <br />o Ac<_ 0 u_ <br />o s..c... 0-..... <br />0- "'- <br /> <br />* ......- AT_ <br />v..D NoD <br /> <br />* n~ OF DEA,.... <br /> <br />21. OAt! C# DfAT" ,.., Dtv 'WI" <br /> <br />i <br />.6' . <br />I~ ~: 211> DATE_.O lUll u.. 'II 21. TIIlEOFDEATH <br /> <br /> <br />~ J 27d", 00'" bMI (lII my ~ .... O<<"UtfCd....".. dIM ref pItCt'" dullO "" <br />~"I"" <br /> <br />4:30 <br /> <br />.. <br /> <br />A <br /> <br />-, <br /> <br />.. <br /> <br />.. <br /> <br />1 -'d' I ...aT <br />29 000108ACC01JSE CONT"""TETOTHE oe;mr 3D. HAS~ORTIS5UE OONATIONIlEENCONSlllEREO' <br />o vES D NO ~ ~ 0 yES ~ 110 <br />at "AMEANOAOORESSOFCE IERI_iIICWI.COIIONEAS_OIlCOUNTYATTORNEV, ,T_.,_, <br />~. <XlLINS, GWf) ISLI\lt) PCLICE IEPAlmf:Nl', \3\ S UXlJSI' sr, GWI> ISLAm, lE 6880\ <br /> <br />.~ <br />I <br />" <br /> <br />:V. REGISTRAR <br /> <br />1 ~ D~n f..ED IIY 1itE~5TAAf:I MJ l>>ti ""; <br /> <br />! JUl 2 1 2004 <br /> <br />fT) <br />::i <br />Ci <br />[ <br />~ <br /> <br />3' <br />~ <br />! <br />2 <br />o <br /> <br />'\ <br /> <br />~7 <br />