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<br />Lot Two (2) of Block Eleven (11) of the Original Town, now the City of
<br />Grand Island, Hall County, Nebraska, according to the recorded plat thereof
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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND~/CES-
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RliiJ:DRo-~(fffFNaWITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTles" --~ IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. /~:;J;Aii;;;;:''''-:i:fi':"~,,-
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<br />DATE OF ISSUANCE ""'j~'flt~i~~Od~~R-~
<br />JAN 2 3 2007 2007 0 13 6 t ASSI$TANT $rArl!\R~R:'
<br />LINCOLN, NEBRASKA HEALT-HANtJ)#JMAN,g4VtCES'
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<br />DlCfl)E -NAMI
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<br />STATE Of NEBRASKA-DEPARTMENT Of HEALTH
<br />BUREAU Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH ) .~)-:;-O
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<br />88 0'85'!1
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<br />1 Of DEATH (Mo... 0.,.""
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<br />,.... Grand Island
<br />IfStOENCI-$T"Tf COUNTY
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<br />''''. Nebraska UII. Hall
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<br />Medical Center
<br />STIIEfT AND NUM'f11
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<br />Guerrero Ernestina Cantu
<br />INFOtMANT - NAME -'EU.1I0NSH" -"MAILING ADDllfSS linEn Oit ....0. NO.. Clf!' OI~ ZIll)
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<br />'9. Philip S. Roman-Husband-S09 W. 7th-Grand Islana,,;'1It.
<br />CEMEtEIIY 011 CllfMATORY--NAME I lOCATION CfTYOITOWN STAft
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<br />20.. Hestlawn Memorial Park Md. Grand . Island, HE.
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<br />2~pfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE. 68801
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<br />iCIAN. COIIONIII'S ~IAN 011 COUNTY ATTOIINn: (r,,.. .. ,.inl)
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<br />908 N. Howard, Gra.nd Island, NE .68803
<br />I DATI RECEIVED 'Y II000nM (Me... 0.,.. ",.,
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