|
<br /> fit ~ on
<br /> \'::1: )>
<br /> r- 'TI p m (,I)
<br /> c: 3; _ ~ :r.:
<br /> ~ ,"" z
<br />I\.) ('\0
<br />s 1: >~
<br />s I ,"n \J> '1\
<br />0') n VI
<br />s ;Ill:; :I: ~
<br />..... ) '0'1
<br />--.,J ()
<br />w
<br />CD
<br />
<br />
<br /> r-.....
<br /> c':;) OlfJ
<br /> c:;;
<br /> A', ~ <:) -i
<br /> "'T' C:l>
<br /> z-i
<br />;;; ~' ..., -IfTl
<br />o::l -<0
<br />c:> - N 0"'"
<br />0 co ""'z
<br />'"T1
<br />0 ~- ;:l: fTl
<br />rn t -0 P- ro
<br />111 :3 r ::0
<br />CJ r l>
<br />C/l en
<br /> w ;::><;:
<br /> )>
<br /> N ~~
<br /> en en
<br /> <.0
<br />
<br />200601739
<br />
<br />RE:
<br />
<br />Lot Nine (9), Block Two (2), Blain Addition to the City of Grand Island, Hall County,
<br />Nebraska, commonly known as 532 East Eighteenth Street, Grand Island, Nebraska 68801
<br />
<br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES
<br />SYSTEM IT CERnFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOROJ)f! FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAnsn~~~poS/~/CH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. '~-~'--->,c-'fJ.~:l~/l;;;'~,:'. ,_
<br />
<br />DATE OF ISSUANCE M.~:'y'fJ~~
<br />
<br />NOV 2 2 2004 20041 t . ib iii A$SISTANTSTATEREGIsrRAR
<br />LINCOLN, NEBRASKA . '. ~ 0 I HEALTHANOHUJIIANSERVlCAS'sYSTEM
<br />~~~ "-~'~~:::~~~"'~::":': ~>~~.." ,,",.., : . .- .'':
<br />
<br />STATE OF NEIlRASAA - DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />~ .~;:' ':":::~~"::'": :~:~
<br />
<br />--:-~-:'-96--w,. 0 7 3 4 2
<br />
<br />! ' OfCEOE~l- "'~Mt: F~ST "';lQ.~ l.A$'f ~ ~"""""""'-rroA"ff'5f5E1:""r~~'7Mr7'~
<br />
<br />I. OTYMOST~T~:~T~n'H~~USA _<WnO>' Everett -rsi AGE'UOI_.Dab~~~R1Y~R ~~:'DAV i I~~:~:~i:'~~~ ~;y.~!
<br />
<br />C I N b ka I I'''' 50 UOS' nAvS 5< HOuRS ....'s J 27 19"0
<br />a ro I eras ____-L__ 76' I anu~ ... ..:~_,
<br />7 SECURTl\' N\.>M6<R .. PlACE Of DEATH
<br />511..10-2651 ~~T~ 0-
<br />
<br />,"..._.~___I 0 ;;R:JuI/IIW1I
<br />! -.
<br />;,....i v>~
<br />
<br />
<br />2T~R
<br />
<br />o f',.;\,II:ilrtgt1(,1fl'(
<br />
<br />iJ Ats..:iI!.t\l,:.
<br />"
<br />W \....iT;...:,~~f:,'.._.
<br />
<br />----_._~----"..--. ~ -.--
<br />! '.1 ,I'4ISltf: CfTY i!f/HS . :;~ -,.c.,i""....,~....ur,rOi~~"'l~' n"
<br />
<br />III. CIT't, TOW"'OAI.OCATtON-oF~DeATM
<br />
<br />Grand Island
<br />
<br />i '. [i1I;o CJ: Hail
<br />-~~.-iiCi"iY'-T~-Oiii.OCi:~~-"""'" ..... . '~.'S/~rANDNUWJeR {1nc~i;;,i'';14:j-''''. ~.. ~~ :~.. ~"&
<br />
<br />Grand Island i hi 'Via Como, 68803 ..., __.J.-~:.." KJ "" 0
<br />"KJ.w.~ DWIOOWED 13 NAMfOl'ilI'<l<JSE IH""".g...__,
<br />
<br />NEVER n DlVORCED Mildred Barrett
<br />,.~ KIND Of IlUSlNESS INDUSTRV 15 EDUCATION ISpoo:oly - <~I
<br />l.i1 0 e...w.. -..y iO"~1 COIIOqO "."n'.
<br />
<br />\IIOOLE F'RST "'DDLE UAlDEN su_
<br />
<br />Ila
<br />
<br />NCE . STATE
<br />
<br />!II> COUNTY
<br />
<br />Nebraska
<br />
<br />Hall
<br />
<br />
<br />10. RACe .,.,;.. WMI 8/.Ick """",an ~n
<br />
<br />"rat:'
<br />
<br />II. "
<br />
<br />Otto
<br />
<br />Dahlke Hortense
<br />
<br />06109/1942-
<br />10/1411945 Mildred Dahlke
<br />!STREET OR R F.D NO. CITY OR TOWN STATE. ZlPI
<br />
<br />Johnson
<br />
<br />1& WAS DECEASED eveR IN uS ......eD FORCes'
<br />,v.... ......., ""'. Q',.._...,..... "'-I
<br />Yes World War II
<br />
<br />MAILING ADDReSS
<br />
<br />
<br />. I ~lC CE"E7ERY ciii CRE"'A TOR' NAME
<br />
<br />~.. "ETHOOOf' IlI5l'6Sl>iON l'~ DATE
<br />
<br />~ llunal 0"."""., 0610111996 Westlawll Memoria. Park Cemetery
<br />21. ce..nERY OIl CREMAWRVLOCATf ON .-.. !;I~' ,.pQWl\o STATE
<br />Apfcl..BlJtler-Geddes Funeral Home D c_ D 00<'11.... I Grand Island, Nebraska
<br />,'__""""'ADDRESS 'STFlfETORR.F.D NO c!TYORr~.STATE_ZIl'I
<br />
<br />1123 West Second Grand Island, Nebraska, 68801-5899
<br />D TfCAU IE..TERONLY:)flECAUSE PfRLlNEFOR 101 'bl.At/D1M
<br />PAIn
<br />I
<br />
<br />- ~~-:--;~:;(,t;;;~~".
<br />
<br />
<br />.(}.r,l~ _ ,,-IWI ""!l"'''''
<br />T OIU,S A CON OF
<br />
<br />I~I Ct.r~"';c: '{)j;J'rr-....\T,v-< 17 J /1
<br />. OUETO.ORASACONSliOUfNCEDf r:~!"''';, "#'7 l<,~,~~:q",,- ~.~ -~.,-- .-.--~_..._----
<br />
<br />I' ,.,
<br />
<br />I ~fSGNr~HNTOONDITp tOlIIS, ~~aohCiU..,~;J;;;';;;;;- '.'~-'~-~r~~:~~~~~~~'~~~~~~D'li4"UTODPSV ~ I,' i5 ~'~~'-';~'{;.:;~:~::.c~,
<br />
<br />iI ).. ~ ~ 1 .-..._ (AQt& ~-54l tt:I ;,._~ i'.io I 'rei; No pt I Yes ~.LJ...~ f1i;} i'\J
<br />111Io. 12130 DATe Of INJUR> (Me. Ooy. YfJ 28<: t<OUR OF INJURV 26d OESi.~"'Bf. HOW "'IJUR> OCCURFlfD
<br />
<br />10-0"-""....: ...
<br />
<br />o -. 0 Po"."'ll , l!OO. 'IO;\JR> A7 WOR!< 2eI, ~=~Y i~"'1J' """, ..'... ~ lt9 LOCA-no..
<br />o - ''''.' '9<- i-Of 0 "" D
<br />
<br />I IV> O~TEOFl)i.::.::~..l'~_.. -1280 DATESlGNfD Ilk 01," !_ ''ll!:OFOEAr~
<br />
<br />k' i-;3-rt; I
<br />II. ~T~-7t., -.l~-~?:iD ~. iUila_'~~ ,~~"' i-~ro~ - :
<br />
<br />~I I7'TO"'_"'''lY.""w:.ag.'~'C"''O<t.lIl''U''''''a-qb'~ :ill_~__'_n._.____'
<br />'''.:,..-ct. A' ~ 1:1 ~. ....i!"ftI dIIIIntJP<<'I'~...to"'~I,~
<br />,_..,HlIOl.. (;-"11""14. I ~___ ,.. T.
<br />:/II OlD'TOIIAl;CO use CONTRleuTE TO TH .'eATH' 130.. HAS ORGAN OR TI58.)t; DONATtc;.N BEEN CONSlllPIiIl' 30. "'AS COOISENT G"'NTE','
<br />~ YES 0 NO 0 UIlKNOWN ~. yes 0 NO [J YES SZl 'IV
<br />
<br />AND _ss OF ClIn'IflIlIIIIIH't'SKluIk ~ -..!w. 0IIl coumv ATTOIIN!VI ,....PnnII
<br />Dr. James Omel, 21 Hi W. Fai ey Ave. Suite rand Island, Nebraklla 6880J
<br />
<br />.. fifO 1_ DATE .UllB'V AEGlST....R ,_, /10. "0
<br />
<br />I JUNIl_
<br />
<br />
<br />..______., ./~_.,iJ ",'.1:
<br />'t.~.:':""i'" ~1,"jl.~'I~~:oI\""
<br />
<br />..;,:,:;~
<br />
<br />.",'_ i ~ t', .; .,. ,I' "'"::_" ~.. ~ _,
<br />.-.'-~-',," jr.;'t~'~,:,~~,.::~"~:~,:., ~:-.,~ ,.-: - '--
<br />
<br />STREET OR " ..D. NO
<br />
<br />STATE
<br />
<br />CITY 0t:1 10\ ;~.
<br />
<br />31
<br />
<br />
<br />CJ~
<br />N[
<br />~r:
<br />~I
<br />
<br />
<br />wr+
<br />co~
<br />
<br />'\:j''''.
<br />\I'
<br />'c.)
<br />
<br />I
<br />I
<br />I
<br />
<br />"
<br />
<br />.~
<br />
<br />,~~
<br />
|