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<br /> <br /> <br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES <br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAPRECOBQiiftLE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES~YSTEM, VITAL ST41}S'TtCSii~TiitN~-j;gCH IS <br /> <br />::~:::::::ORY FOR VrrAL RECOROS. ~i~J~~R <br />MAY 1 7 2006 2 0 0 6 0 4 5 0 3 A$SJSTANT STATE REi;Il!i"T1fAR <br />LINCOLN, NEBRASKA HE~I,.TH)HliDHJ-!!!!{N;'SERVtCES <br /> <br />I. <br /> <br />STATE OF NIIIRAIKA - DlEPQTMENT ()F HEAL 1M . <br />c::rr"AtAlf;;:;YH <s_1&7:C-'S-9 0718-0 <br /> <br />LAS 2. SEX 3. DATI! OF DEATH <br />Swafford June 15, <br /> <br /> <br />-HAUE <br /> <br />FIRST <br />William <br /> <br />MI <br /> <br />Luther <br /> <br />.. CITY ANDSTATI! Ol' IlATH (/I not ill U.8.A. _ ctlIMWy/ <br /> <br />- Altanta, Georgia <br />llEC\JfITY NUUIlEA <br /> <br />1117 W. 8th <br />- STATE <br /> <br /> <br /> <br />Hall <br /> <br />10. -te.....-. ~ ""*- _. 11. ANCESTRY (..g........._~....~, "'., <br />-I ~ tsP*/fyJ. t . <br />White - American Ov <br />'''' OCCUPATION /OM Idnd __........,_ <br />0('--"_ _II'" 0 <br />Heavy Equipment Operator/I <br />18; FATHE!!. _ l'lRllT ~ <br /> <br />Boza.rtll <br /> <br />Collilileflor.., <br /> <br />Asa Cornelius <br />18; WAS DECeASeD EVER IN u.s. AIIM!D FOACE8? <br />IV... .... or "'*-1 I 'I YM. give - -.... III_I <br />No . <br />20L 1IU1IAI..,~. 2Ob. DATI! <br />~... June 19, 1989 <br />B ri.al <br />- SlGHA1}f'E <br /> <br />. Ordinance Plant 1.5:1:-., <br />LAST 17. 1IlOTHf1l. UAIOeN _ M!lDl..E LASt <br />Swafford Narkie E. Walker. <br /> <br />~averne' ";~~:r=fe-l1 ~~~Fl~'i::Ci:n:i~01la~ <br /> <br />2Oc:. CEMETEllY OR CREMATORY -NAME .alY ~ <br />Westlawn. Memorial Park Island, <br />l!2...flJNEft.o\L HOIAf . ~~'AND ~ ,J'JAll!. <br />1123 W. 2nd, GrandIsl,~d;-..6880f <br /> <br /> <br /> <br />.,..~-- <br /> <br />r,;~ <br /> <br />--....-- <br /> <br />- <br /> <br />DUE !S. Of! AS A UENCE OF' <br /> <br />-'--- <br /> <br /> <br />PART OTMER SlOHlFlCANT 8 - CondIlIor. ~ to _1M not_ <br />p <br /> <br />.. WAS CASE <br />~. ClIt. '~.' ... ... <br />.. ~iW"',..- ~. <br /> <br />... ACCIOENT. SUIClOE; HCMCIOE, .... DATE OF tNJUfIY (MI..QIy. Yr./ 2tIc. <br />011 PENDING INVESYlQATION (t/pfJcIIy/ <br /> <br />... INJUAY AT WOA1< <br />I (Specify Y'N {J< Nt1/ <br /> <br />ClTYOA TOWN <br /> <br /> <br />STIlEET OR FlF.D. NO. <br /> <br />2lla. DATE SIGNeD (Mo., Der. Yt.) <br /> <br />... 11ME <br /> <br />:nt <br /> <br />ill i 2tc. ~ DeAD ~. Der. W./ <br /> <br />:1 ~ 116<0. 0..'" ~oI_ WId'CO' ~ In ...,.........._---. <br />~ liS .. _. dlIIIlfId .. _ dUnl_ ...... ~ <br />Tile - <br />0IlGAN Dl'I TlSllUl; DONATION eeeN toNSlDeFtll;O? <br />~ <br /> <br />ad. PFlDNOUIiICB) DiAD "..., <br /> <br />.... WAS tlONaENT' BIlAN1't!m <br /> <br />~ <br /> <br />O'I'U <br /> <br />( <br />G. Settje M.D. <br /> <br />NE. 68803 <br /> <br /> <br />LEGAL DESCRIPTION: Lot 4~ Block 8 in Wallichs Addition to the City of Grand Island~ <br />Hall County~ Nebraska. <br /> <br />I <br /> <br />