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' FOR VITAL STAT ISTICS USE ONLY Place-.................... A -. ............. ........... 13 ....... ....................... C .......... .................... 0 ............ .. : .~~~~E U ...................... MV ... ..................... NSIC., --^-.~~~--~~~~~~ ........................ ~ .... ........................... ................ Census Trod No. 00av...... ...................... ~~ ................... ................................................................................................ .................................................... ~ ......... _~_. WC ......... ... ............ .... ...... ~~~'-~'~~^.'~'^~-~^~~~~~'^^~~--'' ................................... ..... ........ ~-~~'—~~-~ .............................. ^- Rojoct... .............. ....... ................. ~~^~--'~~-^~~~~--~~-^---'~ ........................................ ~-^-~-'~~~'^�^~--~'-^~~~ U hereby certify this to be a true and correct copy Uf the original filed with the by— VOW— T �ERR� L =L� Signed in my 7presen!ce��/-?z�F_da of 9 4r, M y Cj m m. E x p. -Notary PubIric BUNW4F VITAL STATUM08 200608527 IDIXE WWI 2. 1.2 Evelyn Marie Ewoldt Female Novemb Kearney, Nebraska 741 February 2, 1922 Park Place Nursing Center CID" AWG&J Sid, CITYMMURaTio"'Or Dom Y" No Grand Island El Io Elt Hall Hall Grand Island 312 9. 19th 68801 Y., E] PA 0 ark offeemmu, WOO N ft. ?woo CIVATH Pa. 0* W4 DIM it PARRIN RIC" LAST 17. MO.— -` AM Daniel A. Ewqldt NO Ll Alk jUr-E-.�9tb7stroot, Grand Island, N*braaka 68801 Nov. 5, 1996 rial Park U1 3TA79 -' LU - Livinaston-Sondermann F.H. 0 Grand Island, Nebraska 505west Koenig., Graad.Islan4l, Nebraska 68801 thl ' FOR VITAL STAT ISTICS USE ONLY Place-.................... A -. ............. ........... 13 ....... ....................... C .......... .................... 0 ............ .. : .~~~~E U ...................... MV ... ..................... NSIC., --^-.~~~--~~~~~~ ........................ ~ .... ........................... ................ Census Trod No. 00av...... ...................... ~~ ................... ................................................................................................ .................................................... ~ ......... _~_. WC ......... ... ............ .... ...... ~~~'-~'~~^.'~'^~-~^~~~~~'^^~~--'' ................................... ..... ........ ~-~~'—~~-~ .............................. ^- Rojoct... .............. ....... ................. ~~^~--'~~-^~~~~--~~-^---'~ ........................................ ~-^-~-'~~~'^�^~--~'-^~~~ U hereby certify this to be a true and correct copy Uf the original filed with the by— VOW— T �ERR� L =L� Signed in my 7presen!ce��/-?z�F_da of 9 4r, M y Cj m m. E x p. -Notary PubIric 1.2 2k, W"Fff we ImeWA&W Y" No ark offeemmu, WOO N ft. ?woo CIVATH Pa. 0* W4 DIM AM Alk ' FOR VITAL STAT ISTICS USE ONLY Place-.................... A -. ............. ........... 13 ....... ....................... C .......... .................... 0 ............ .. : .~~~~E U ...................... MV ... ..................... NSIC., --^-.~~~--~~~~~~ ........................ ~ .... ........................... ................ Census Trod No. 00av...... ...................... ~~ ................... ................................................................................................ .................................................... ~ ......... _~_. WC ......... ... ............ .... ...... ~~~'-~'~~^.'~'^~-~^~~~~~'^^~~--'' ................................... ..... ........ ~-~~'—~~-~ .............................. ^- Rojoct... .............. ....... ................. ~~^~--'~~-^~~~~--~~-^---'~ ........................................ ~-^-~-'~~~'^�^~--~'-^~~~ U hereby certify this to be a true and correct copy Uf the original filed with the by— VOW— T �ERR� L =L� Signed in my 7presen!ce��/-?z�F_da of 9 4r, M y Cj m m. E x p. -Notary PubIric