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<br />
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA s~~;- 100675
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS.
<br />
<br />I
<br />
<br />DATE OF ISSUANCE
<br />
<br />~l-~
<br />
<br />STANLEY S.C~OP~R,< DIRECTOR
<br />".,. ....
<br />BUREAU OF VITAi~S1ArISTICS
<br />
<br />OCT 1 6 1987
<br />LINCOLN, NEBRASKA
<br />
<br />Westerly 28 Feet of Lot 2 and all of
<br />Lot 3 in Block 9, Ashton Place, City
<br />of Grand Island, Hall County
<br />~TATE OF NEBRASKA-DEPARTMENT OF HEALTIt
<br />Nebraska. BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />
<br />DfCfDfNT NAMf
<br />
<br />fiRST
<br />
<br />MIDOlE
<br />
<br />LAST
<br />
<br />DAlf Of O(ATH (Mo.. Oar. r, j
<br />
<br />Laferne
<br />
<br />JSevtember 23, 1987
<br />
<br />Hall
<br />
<br />Hall
<br />
<br />1,5<
<br />
<br />Grand
<br />LAST
<br />
<br />If HO~ 01 INST '"ditOle DOA
<br />Ovtpa,..,,'/l_' .... I"pol.e"" ISPK""
<br />Medical Center u. Inpatient
<br />STun AND NUMlfI INSIDE CITY liMITS
<br />t$pKifLr.. or No)
<br />Charles St. 15. Yes
<br />MIDDlE LA T
<br />
<br />
<br />Ub.
<br />.E!~DENCE -STATE
<br />
<br />Grand Island
<br />
<br />COUNTY
<br />
<br />MIDDlE
<br />
<br />16. Wal ter
<br />
<br />WAS DfCfASED fVfllN U,S, A!lMlD fOICfS?
<br />'.y;. tiN;; VIl.tllU r-I. v.... ..of Gild do..... o. MAocel
<br />
<br />
<br />BURIAL. Cremation, Remawol DATE
<br />. Sept. 24,
<br />2Da. Cremat10n 20b
<br />fMlAlMU SICNAruu & LICENSE NO
<br />
<br />Riness
<br />
<br />Jane
<br />
<br />Welsh
<br />
<br />21.
<br />
<br />17,
<br />I NfOI.a.lA.NT _ NAME _ .lLAflONSHI' _ MAILING AOOIES,S (StUI1 01 If 0 NO. (In 01 TOWN, STAU. lIP)
<br />
<br />l~Ugust E. Hackman-Husband-240~s~~nefta~res6~~?!Grand
<br />
<br />CfMnflY 01 CIfMATOIY NAME LOCATION CITY 01 TOWN STAn
<br />1987 I Central Nebraska Crematory
<br />,0< 20d Gibbon, Nebraska
<br />FUNEIAl HOME NAME AND ADD'US ,$ftln 01 . f 0 NO eln 01 TOWN. STAU. II')
<br />
<br />1"Apfel-Butler-Geddes 1123 W. 2nd, Grand Islana~89t.
<br />DATE SlGNfD ,Me Dor, Y<./ 'I HOUI Of DfATH
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<br />HOUIOF DEAtH 0 . ;(~l~~t ~..:?~~~~;,f~DfAD 'IONOUNCfODEAD/Ho.,j
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<br />NAMf AND AlIOIfS Of CIITlfl
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<br />SEP 28
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