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<br />
<br />STATE OF NEBRASKA
<br />
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SE,RVICES
<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 STATIST~~HICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.,~~~-",--,-'"':"__""'-FL~~ -~,_
<br />
<br />
<br />DFEBF~S3U~~~~ -m-t~~R
<br />2 0 0 6 0 114 2 jSStST_=s'r~~~al$T/fI4R
<br />LINCOLN, NEBRASKA ~~LiIJ. AND HOfiAKSjI!V<<!ES
<br />,-_ '_ __ . .. '. -""7'"=~."
<br />
<br />STATE Of NEBRASKA- DEPARlMENTOF HEALTH A.'m HUMAN SERYK'ES fn,ANCI! OOSlJftOU
<br />
<br />CERn~~~~EArn "'-- --- ......_....'"-'~-~QA;c:o-" 12072
<br />
<br />'\:.:.-
<br />"',
<br />~
<br />
<br />FIRSi
<br />
<br />MIDDlE
<br />
<br />l.lSl
<br />
<br />
<br />25, 1924
<br />
<br />i 1 Dt::Cf:.D!:.Nl - NAME
<br />,
<br />
<br />, SEt
<br />
<br />t-4 (1,Ionth O~.. y..,./
<br />
<br />i-tobert
<br />
<br />Francis
<br />
<br />GreelValt
<br />
<br />Male
<br />
<br />4 ClTv .NO STAlE. of 61ATH '''1JOI~OS~ ~countrvt
<br />St. Libory, Nebraska
<br />
<br />~ AGE -1MI_. uNDER 1 YEAR
<br />IV,,, 79 !>b lIOS [lAYS
<br />
<br />7 SOCIAL SECuATIY Nt,.!M6E~
<br />
<br />507-24-5608
<br />
<br />&I PLAC~ OF DEATH
<br />
<br />'!OsPtT~
<br />
<br />o Inp....
<br />OER~
<br />
<br />DDOA
<br />
<br />Q!.~ER
<br />
<br />I!] ""'''''9-
<br />0--
<br />o 011o< .St>><:",
<br />
<br />8b FACILITV. Nam&
<br />
<br />,. ~ 11!5MIIIon. ~.., ..rtt1~J
<br />
<br />Gran:l Island Veterans Hane
<br />
<br />10 ~ACE. Ie g. WtII~ ~k >\~iC" nMI'I
<br />""'. '5"",,''''' Whi te
<br />
<br />11 ANCESf,:tYleq ......,...lIiCat1..,.,rMn.Mcf
<br />'~~I German/Polish
<br />
<br />
<br />I it ~ ecrv ....-rs
<br />v.1!] ... 0
<br />
<br />8e CITy TOW,.,. OFllOC~ TlON. OF DEAtH
<br />
<br />Grarrl Island
<br />
<br />i 9ft RESIDENCE. $TATE
<br />'Nebraska
<br />
<br />t 9D COUNTY
<br />Hall
<br />
<br />'3 NAUj;OFSI'OUSf ,.__-_
<br />
<br />114a :;SUALOCCUPAT50N IG11If!tlfrdolMYtaonetkl:JII9mo!i1
<br />. OI~ i"'.1hItM I' t~edl
<br />, Construction
<br />.8 ~AT~R. NAME ~"ST MIDDLE
<br />
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<br />CoIfgf '1 4; (.II" y
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<br />IMUN Sl-.wE
<br />
<br />John
<br />
<br />(NMI)
<br />
<br />Anastacia
<br />
<br />Lucinda
<br />
<br />Grafek
<br />
<br />18 WAS OfCEASED EVER IN uS ARUED FORCES' 8/26 1944- ,oa INFOIll.fANT - NAME
<br />Y~S"'O"'''''' U:S:"'NavY...oI--'6/07/1946 I Eu ene Greenwalt
<br />.11II 'NF~NT WIlLING AllDRESS 'STREETORRFD NO. CITY OR TOWN STATE ZIP,
<br />
<br />325 Hardy Rd., St. Libory, Nebraska 68872
<br />
<br />
<br />NO
<br />
<br />2,. ~THOO()f OISPOSlTIOI'; 2'b DATE
<br />
<br />1254
<br />
<br />I!I au.. 0 _., 11/04/2004
<br />
<br />21< CEU!;TERVORCIltWllOl'V .......
<br />Westlawn MelrDrial Park
<br />
<br />2'. C~~ERVORCRE"'ATORYLOCATION 0" DI' TOWO< STATE
<br />o c...- 00."..", Grand Island, Nebraska
<br />
<br />.2~ ~uNE~ HOME ,aODFlESS IST~F.U MA,f 0 t\fO CITv oR TCWWN Sf~le..ZtP)
<br />3213 W North Front St., Grand Island, Nebraska 68803
<br />
<br />23 _llIATE CAUSE ,ENTER 0t<L V 0t<E CouSE "ER lINE FOR 'at ID' AND 1<11
<br />"ART
<br />I,., CardiopuJmoncu:y Arrest
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<br />OVE TO, OR AS . CONSEout:NCE OF
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<br />- 0 -
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<br />DuE 10 OR AS A CO>ISEOOENCE OF
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<br />~aU~TE{]f"oe"'TH ,U(l ~r 'If;
<br />
<br />,,;;: ~tober 31, 2004
<br />
<br />ii.:Ii i 2'" DOlE SIGNED '<10 0-0. ",
<br />~p
<br />~.!..'.itNavember 1, 2004
<br />! \ 27a T{j~~OI"""It,.
<br />IJr.. t.....~l ~
<br />I '~.InQT"l
<br />29 OlD lQ8ACCO USf COOIl
<br />
<br />DYES D VES
<br />
<br />3'1 NA-..t.u.o ~S$ Of 'f'AT"'~ ~'f'SIaNw, (:.C)RCHi:! S PHYSlQAfIf OR COIJt(r'Y AnCJtWfV~ ,T",~ PooII
<br />
<br />, Sheridan T. Arrlers::>n, M.D.,
<br />
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<br />; 1fA ~~~v 'I&c~' titrrn 5IJeet, IaCUy
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<br />2;;;---~-'
<br />
<br />2fitt nATeOF~v i~ lJ4v y,.J 26c HOUROF......uRv
<br />
<br />28g. lOCATION
<br />
<br />STREET OR RFD NO
<br />
<br />:"7'" ()R. 'T0Wt.
<br />
<br />STATE
<br />
<br />_ DATE stGNE"D IMo~" ..., i
<br />
<br />., TIUE OF DEAr..
<br />!
<br />
<br />L~~
<br />
<br />
<br />7:20
<br />
<br />A. ..
<br />
<br />i>
<br />
<br />1$ J ~ " ;l8e AAONOuNCED DEAD 'llo 0.,. y, J
<br />
<br />"i~
<br />
<br />~Ie 2Ie OtttnebM401.~andor~.,,",",,~ON:!IJl~.
<br />r J Co the tme. G"*,II'1CI. pIKe and 0Iie 10" ~..I _
<br />
<br />I....~DDEAO _
<br />
<br />..
<br />
<br />:lu 'ME OF [)iAT)ot
<br />
<br />..
<br />
<br />30 D WAS COI<<ltNT GIWlTED'
<br />DYES
<br />
<br />[j1OO
<br />
<br />68803
<br />
<br />I 321 ~(;;SfRAR
<br />
<br />;m, DATE"--EDBVRWlSl..... .... ~ Y'I
<br />
<br />NOV
<br />
<br />
<br />Fractional Lot One (1), in Fractional Block Three (3), of Arnold & Abbott's Addition to the City
<br />of G~and Island, Hall County, Nebraska and its complement: Fractional Lot One (1), in
<br />Fractional Block Fourteen (14), of Bonnie Brae Addition to the City of Grand Island, Hall
<br />County, Nebraska
<br />
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