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<br />l. <br /> <br />fr <br /> <br /> <br /> <br />101019 <br />88- <br /> <br />~!.!.l!~!!.! <br /> <br />STATE OF NEBRASKA ) <br />) ss. <br />COUh'Tlr OF HALL ) <br /> <br />~~/ ~. /.(l;~~~~ __, after being first duly sworn on oath deposes <br /> <br />and says that he is a resident of Grand Island, Hall County, Nebraska and that <br /> <br />he is licensed embalmer and funeral director in and by the State of Nebraska; <br /> <br />That, ~...y 7(1ar..fL/:a.d-.<..J <br />did die at J...--,:y(' a-"//2<u'~ /7..e.--_ <br /> <br />, a resident of ~4~ d,/A'~ /2.e.--~ <br /> <br />on V.&.vr <br /> <br />the body of ~ /)h::J-r-.b;'-~..v~u <br /> <br />/ ~ /9~~, and that he did <br /> <br />prepare <br /> <br />, for burial on that date; <br /> <br />That, he did supervise the burial of the body of tf//:7';v //~~~....//~7/.."r) <br /> <br />in ~~/;-/-""t', t1A/"",~/~/J)1/ <br />on 9 /u.... u ..:J. ...:<,. / '7 ~ .2...- <br />That, h. did see the dead body of <br /> <br />cemetery, located in AAN...../ _L-th?~/~ /l--e-- <br /> <br />did positively identify same; <br /> <br />&--P':rd ~1~~/;-o/?~) <br /> <br />and <br /> <br />Further affiant sayeth not. <br />Signed at Grand Island, Nebraska this d /?.A""r day of 7/?/J././'..# /' , 19 '1. t <br /> <br />~ ); VIA PI!. f ~/.;:. <br />~.. <br /> <br />Subecribed and sworn to before me, a norery publlc, thle .<'~ day of ~~ <br />19 &8. <br /> <br />r f-" w<~. '--. .- -, <br />,.., U..h,,;_..,';._.,....,_._..,~ .l~-:-. <br />~:". )>:'0'<0.-, _ ~ :. . ~-,' [~ ~~-L-~' t'.,~~Ti~{J 1 <br />b'~-:" - '.~..1.:J--1y' I <br />--------- --------_: <br /> <br />My commission expires <br /> <br />e~;J.... -gf <br /> <br />~_l~ <br />Notary Pub1 c <br /> <br />L <br /> <br />L <br /> <br /> <br />~ <br />