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<br />I
<br />10020'3
<br />
<br />88-
<br />
<br />I"
<br />
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES TIlE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPART~T:\.Qt *EA~TJ!.
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOS'tro~"'FQR-,'/"'.
<br />VITAL RECORDS. . :':.,..' /'. ,', .'...., ". J-',
<br />.. ?jJ''!O' f> t,,, "', \ '.~.i.',
<br />~...,.. .' . ...W-.:l..~l..."\ :'J_,
<br />'".:,,:- J- ". .. lJ-J J
<br />~ .: ,- ,. ""J': c,) -
<br />.. ? w I, J_,'...... .. ..
<br />. t.;.) ~ ";0"'-." lt~<1 "". .. c..-) ...
<br />STANLEY S. ".~O~?-~~'''P..tRE_C~_-
<br />'BUREAU OF ViTA\.:s1~~~Cs'
<br />
<br />NOVt7111
<br />
<br />DATE OF ISSUANCE
<br />
<br />LINCOLN, NEBRASKA
<br />
<br />.-
<br />
<br />DECEDENT N....f
<br />
<br />fllST
<br />
<br />STATE Of NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH (2. ,L/L;":,
<br />M'DDlE lAST SEX
<br />
<br />
<br />I.
<br />lACE (.". Whit_. aloe., A....'ic:o" OIl'GIN/DESCENT (e e .ltolion_ Me.ican_
<br />,.Jio"o".lISp..ify)
<br />.. Whi te
<br />
<br />Harriet
<br />
<br />1987
<br />
<br />1923
<br />
<br />150. Nebraska I5b.
<br />fA Hf. N....E
<br />
<br />Hall
<br />M'DDlE
<br />
<br />1405 iof. Hwy 1134
<br />
<br />If MOS' _ 01 INST I!u'icol. 00..
<br />OwIPtlli....JI_. Roo. . l"pOli...' 'Sp~;frl
<br />Inpatient
<br />INSIDf CITY liMITS
<br />
<br />~~:~~~~. or No)
<br />
<br />lAST
<br />
<br />MIDDlE
<br />
<br />COUNTY
<br />
<br />Nursing Home
<br />STIUT AND NUMBU
<br />
<br />Ub.
<br />IUIDENCE -STATE
<br />
<br />Grand Island
<br />
<br />fllST
<br />
<br />William
<br />
<br />H.
<br />
<br />Ina
<br />
<br />Pruett
<br />
<br />MAILING ADDIESS (Sflut 01 '.f 0 NO. CIJY 01 TOWN, st.n. ll')
<br />
<br />,~ilma McVa -Daughter-1210 W. Nortfist~ggt ~~:-a~~g!
<br />cEMnUY 01 CIE....TORY N....E lOCATION CITY 011 TOWN STATE
<br />
<br />2~. Grand Island Cemetery 2~ Grand Island, Nebraska
<br />fUNERAl HOME NAME AND AOOltfSS (nlll1 01 I.' 0 MO. Cln 01 TOWN, STATI. IIP~
<br />
<br />Apfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.68801
<br />DATE SIGNED (Mo. Doy. y, I HOUA Of DEATH
<br />
<br />i~
<br />.c-
<br />i~~ 7.0.
<br />~ f 5 .. PIONOUNCtD OEAD
<br />t~t: i (Mo., Do,. y,.J
<br />utz 2.tc.
<br />~2g 0............. ..aaia.tiUt .Pld,.. ...........ti_..i" '"" ."in,.. c!'.o'" Ol;tw"ed at
<br />B . the ti_. ...- .11" ploe. aft" ..... .. 1tI.. t:avte(ll ,~
<br />
<br />2.b
<br />'IONOUNCED DEAD {Hour,
<br />
<br />10
<br />
<br />2'.
<br />lEGIST.....
<br />
<br />David Colan
<br />
<br />Grand
<br />
<br />Island, NE. 68803
<br />DATE IECEIVED IIY IEGISTRAI (Mo., Oar. Y,.'
<br />NOV 4 1987
<br />26b.
<br />
<br />260. (Si,..Oh,,'.'....
<br />27. IMMEOIATE CAUSE
<br />'AIT
<br />:.1 j\I\ L 'f'A-S 'T A- 'Ttf..-
<br />DUE TO, O. AS ... CONSEQUENCE Of,
<br />
<br />l...'.nrollt....._ _... e",d dMth
<br />
<br />~NrfA
<br />
<br />rJl 'rlU) l~
<br />
<br />I Y h'Lo.
<br />1....,...IIt...._ _loaf .,u' d_'"
<br />
<br />''''terrell It..-.- ...... ell',1I c'_1tl
<br />
<br />
<br />Id
<br />'A.T
<br />II
<br />
<br />Dl A-~i.-.z..s
<br />
<br />wAS CAsa IIU.IID TO MlDtCA.L
<br />tlAMlNII CM COlON"
<br />l;;~'" ,.. ~ ~
<br />
<br />,..II stGNI.tCAHT CONOtTtONS (..dif___ ,_'rilt"ti.., .. d_th b... 1101 r.to~
<br />
<br />DAlIE Of INjun (...... DOl', Yd
<br />
<br />Stlllt oe ._'.0. ....
<br />
<br />(I" 01 TOWN Sf""
<br />
<br />r--
<br />
<br />To be recorded upon following real property:
<br />
<br />Lot Seven (7), in Fractional Block Three (3), in
<br />Arnold and Abbott's Addition to the City of Grand
<br />Island, Hall County, Nebraska;
<br />
<br />L
<br />
<br />(.
<br />
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