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<br /> <br /> <br />STATE OF NEBRASKA '. i <br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND:HUMAN SERllICES <br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIG/~~1iEf;9'if.iff!iN:E1LE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL s~~iE6tt~W#/CH IS <br />THE LEGAL DEPOSITORY FOR VITAL RECOROS. iff ~ :'{5o. o. ~ =:; I-'~ <br /> <br />OATE OF U;SUANCE .. ~~~~j:!:ER <br />AUG 3 1 2006 200607977 1AS"SISTANT STATE Rj!tfBsifRAR <br />H~.LTHANQ!{~AIi SEW ICES <br /> <br />. ..cc ."..'~~-: 1 4 5 45 <br /> <br />LINCOLN, NEBRASKA <br /> <br />Nebraska <br /> <br />STAlE OF IIIIftMU -DEP~OFNlW.TH ":..~- <br />ItIMAU Of' VITAl. STA11I1'ICS \ __ .- <br />CERTIFICATE OF DlATH ~ 0 <br />"~- r_ r 0A'lE0F~ .....-- <br />Nels Levene Male ~.~;=~. 3,1994 <br />!5olo. ~......1WI\Idlv I.IIClU I QA' .. ft iiiiin:l.... ... 'loll <br />76"1 5<.~' -- illS, 1918 <br />.. "'~OI'DI"lJoI <br />~~ 0 -- OMJI' IE-..e- <br />O ER~ D- <br />o DOl 0 0Nf....... <br /> <br /> <br />1tI1>IJl_"'__..-J <br /> <br />\.0 <br /> <br />lei _cm'LMfS .. COIlIllYOI'OOlJol <br /> <br />,. <br /> <br />HlIbraaka <br />...... -- -_. <br />...-... <br /> <br />American <br />'f!> lCIIIOOI' .-&SINDI,ISTAY ,,-\t) <br /> <br />Union P~:ific Railroad <br />~E LAST 17 lAOTlER <br /> <br />~i.. <br />.. . <br />~"...'"' <br /> <br />-- <br /> <br />.. <br /> <br />HilIIIilton <br /> <br />Elsie <br /> <br />~. ~OfI(:IlI;W.1OR\'1lM1IE <br /> <br />Dee. 6, 1994 Grand Island Cit <br />21~ ClII1E1BfIOR~TORVI.OCl\TION c;nvORTCl- SfAn: <br /> <br />Grand Island, Nebraska <br /> <br />---~ <br />,~~ <br /> <br />----- <br /> <br />I1>l <br />t1IJl>lo.ORMA <br /> <br />lei ' <br />Q~ !llOIIW~ll C(lNlll11ON8- <br />p~~ t...-. <br /> <br />2lla ... <br />O-O~ <br />0-0- <br />0- ~ <br /> <br />l!lIlI I.OCI\ lION <br /> <br />STftEET 0'< RJ'I1. MO. <br /> <br />CITY OR TOWI< <br /> <br />ST"~ <br /> <br />l!6o-lNJURY..,WlJII( <br />,..0 NoD <br /> <br />EI ;;;=:~ ~:~;;4 i!t! .. DAtESIGNEIl ,M) Oav v" 1- l"OF~lJoI <br /> <br />Il! 27b DATE SIGNED ,""'". Yr' IE ~ ~ PRONO\IHCEO OEAl) ,''''' fMt. Yr I 2Id. f'A(JNCl,NC~D OEAD' _I <br />f" ",l<~ I <br />.~J~ DECEMBER 7 1994 ~ !lW~ .1 <br />. l1tJ lONbIOtoll'n"Jtcl"lClWll8(lgO ~octutfM."''' tMd~duelQrhv f\J~ ~ L,.I - ()rl11c"'d~__"l~atKtQl~"'my()plftlll)n(ll!lMl'l~. <br />_>1_. W ---'\' \ ~lJ,,-_ J.( ~\ b ~ ""',"'.._MdplOt..1I'd'*"'IO....""*'l$/- <br />I _r..., .~ IS ft', \ld '...,'....1. <br />2t 00 T08ACCO \;se. CONtMleJle- 're IHf: ~"TW -------~SORa-.N@TiSSut OCUATJON a~::'N (',()NStOE~Drl . >:l.b w,t.S COfI4SENf GFlAHTEO'i' <br />o V€S 0 ~___~~UNKIODWIl-.----L_. [] v~s ~ tlO 0 YES 0 lID <br />3. _ .....,ADDR€SSOf CEI<fIl'If" ;.~vSIC""".CO"QItt;RSl'tfYSlC1ANOl<COUt-lTY ATlOR>if:Y; /T.".",_ <br /> <br />Lot Twelve (12), in Block One (1), Knickrehm Third Addition to the City of Grand Island, Hall <br />County, Nebraska <br /> <br /><::> <br />N <br />o <br />o <br />0) <br /> <br />~ <br />[ <br />G;- <br /> <br />o 5" <br />--.J ~ <br />2 <br />3 <br />a <br />~ <br />\J\ <br />\1'\, <br />. C::.> <br /> <br />CD <br />--.J <br />-.J <br /> <br />'" <br /> <br />.. <br />