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<br />(J) <br />(,I> <br />___ .. .. . HIt/'--/' L t:/,' d''1 <br />Lot EIght (8), In Block Nme (9), in Wallichs' Addition to the City of Grand Island)Nebraska <br /> <br /> f? 1)<:::::' ;;0 no <br /> t1 o :s m <br /> "'n Xl> <br /> g'~ c: m en <br /> ~~ Z n~ ~1 <br /> 'Z 0 ;::JI; <br /> en -.;. ~ !{>> <br />I\.) nen U\ <br />CSl ~ U\ t 1'li::J: <br />CSl \J\ <br />0) o<'uJj ...., <br />CSl 0 ~r <br />~ oQ - <br />-.....J o If' . <br />CSl P <br />CSl <br /> <br />..-....;0 <br />c:::> <br />~ <br />c;r, <br /> <br /> <br />::3 <br />::::J:) <br />-<:: <br /> <br />N <br />en <br /> <br />::0 <br />::a <br /> <br />Ir" <br />...... <br /> <br /> <br />.- <br />Co.,) <br /> <br />O(/) <br />O-j <br />c:: l> <br />z-j <br />-f/TI <br />-<0 <br />0"Tl <br />"T1z <br />:::c n; <br />:r> to <br />r ::0 <br />rl> <br />(/) <br />;:>l; <br />l> <br />-~ <br /> <br />~I <br /> <br />o~ <br />en <br />o <br />-C <br />-.J <br />o <br />O2 <br />o <br /> <br /> <br />\S'. <br />is- <br />() <br /> <br />200604700 <br />STATE OF NEBJI.ASKA- DEPAIl1MENT OF HEALlH AND HUMAN SEJlVlCES FINANCE AND SUPPOR.T 298698 <br />VllAL STAnsl1CS <br />CERTIFICATE OF DBA TH <br /> <br />, DECEDENT, "lAME <br /> <br />,'FlST <br /> <br />MIDDLE <br /> <br />I.AST <br /> <br />2 SEX <br /> <br />3 DATE Of DEATH (_o.r r_1 <br /> <br />Geraldine Evel <br />.. CITY AND STATE Of BIRTH (.Mlit! US-A., _ctIUI#yl <br /> <br /> <br /> <br />Female <br />UNDER 1 DAY <br />s.c. HOURS MIN$ <br /> <br /> <br />72 <br /> <br />Palmer. Nebraska <br />.. 7 SOCIAl. secuRTlY NUMBER <br /> <br />So PI.ACE Of DEATH <br />':!25"IT AI. !J <br /> <br />o <br />o <br /> <br />ON...."'lMome <br />o Flts<Jence <br />o """' (Sp<<"r' <br /> <br />In_ OTHER <br /> <br />506-28-9993 <br />8b FACILllY - Name <br /> <br />(.nof~ 1P.._.nd~ <br /> <br />ER 0Utp-.. <br /> <br />DOA <br /> <br />. Universit Of Nebraska Merl. Center <br />Ie CITY TOWN OIHOCA TION Of DEATH <br /> <br /> <br />eel INSIDE CITY LIMITS <br /> <br />Omaha <br />9a RESIDENCE - STATE <br /> <br />(Ih;/vding Zip Co<>>I <br /> <br />68801 <br /> <br />13 NAME Of sPOuSE I.""'. 9"'" ""'-'-1 <br /> <br />Y.. IX] No 0 <br /> <br />Nebraska <br /> <br />ISpoclfyl <br />German/Scotch/Irish <br />"b. KIND Of BUSINESS INDUSTRY <br /> <br />22, 1929 <br /> <br />!lot. INSIDE CITY LIMITS <br /> <br />Wa e Scarborough <br />15 EOVCA TlON ISpoclfy only nq.. 9''''' <ompIolocll <br />ElomonIaIV '" s.con.laty 10-' 21 eo.oge "" c>- 5-1 <br />11th Grade <br />MIDDLE ......DEN SURNAME <br /> <br />FIRST <br /> <br />Restaurant Food Service <br />MIDOLE I.AST 17 MOTHER FIRST <br /> <br />Glad s McClure <br /> <br /> <br /> <br />________ h <br />MAILING ADDRESS <br /> <br />Grand Island Nebraska 68801 <br />210, UETHODOF OlSPOSlTION 2'b DATE <br /> <br />21C CEMETERY OR CREMATORY NAME <br /> <br /> <br />[XJ~ <br />Oc..n-.OD<>\at(Jn <br /> <br />ORtmovOI Mar. 16 2001 Rosehill Cemeter <br />2'd CEMETERY OR CREMATORY LOCATlON CITY OR TOWN <br /> <br />Palmer <br /> <br />Nebraska <br /> <br />STATE <br /> <br /> <br />I <br />I <br />I """"'oJ <br />I <br />I <br />I <br />25. WAS CASE REFERRED TO MEIllCAl. <br />EXAMINER OR CORoNER' <br /> <br />o -- 0 u.-munod <br />o - 0 2It INJURYATWORK <br />o _<Ie <br /> <br />M <br />2llI ~~~RY (~_ Ia,.. ""MI, _ 269. LOCATION <br /> <br /> <br />STREET OR R.F.D. NO. <br /> <br />2aa. DATE SIGNED IMe o.y Y,.) <br /> <br />28b TIME OF DEATH <br /> <br />28d. PRQNOUNCEDDEAD (~I <br /> <br />M <br /> <br />28< PRONOUNCED DEAD (Mo. o.y, y,.) <br /> <br />CITY OR TOWN <br /> <br />STATE <br /> <br />M <br /> <br />2&.. On the buaS r:J e.arY\lnatIon and'~ ItlY8StlQanon.1n my CJC)II"IIIOn dNI"I oc:cunwd. <br />!he >me, dOle and pia<< anoeM"'" couso('I_. <br /> <br />ONO <br /> <br />00 So. 42 St. <br />Omaha. NE 68198 <br />32t> DATE FILED 8Y REGISTRAR (Mo.. o.r Y'.I <br />MAR 2 3 20m <br /> <br />This certifies this document to be a true copy ot an original record on file with Vital <br />Statistics, Douglas County Health Department, Omaha, Nebraska. Certified copies Must have <br />a raised seal in the area to the left. Reproductions of this qreen certificate Are not <br />legal copies. <br /> <br />Da te issued: <br /> <br />MAR 2 3 2001 <br /> <br />~~~ <br /> <br />Registrar I <br />