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<br />
<br />88- 101061
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<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 .W}HCH ;IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS. ~ p.: L'." T ':':;: ',i'
<br />. ~ ! :-, , . I
<br />
<br />DATE OF ISSUANCE-~::!' .; ~ I 1\i:.1I+
<br />. l ~: " \, ~ P ,
<br />
<br />FEB 9 1988 ~,:i
<br />. II .
<br />LINCOLN.' NEBRASKA ~.:'.: j
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<br />STANLEY S. COOPER, DIRECTOR
<br />
<br />
<br />STATISTICS
<br />
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<br />
<br />DECEDENT
<br />
<br />fiRST
<br />
<br />NAME
<br />
<br />I.
<br />
<br />Jessie
<br />
<br />1988
<br />
<br />.. ,.
<br />CITY AND STATE Of IIUH (111"101 ;1"1 U.S.A..
<br />name COUI"I""J
<br />8. Grand Island,
<br />SOCIAL SKUIITY NUMBU
<br />
<br />April 9. 1918
<br />
<br />506-22-5867
<br />
<br />Ub. Grand Island
<br />IESIDENCE - STAn COUNTY
<br />
<br />. "0. Nebraska ISb.
<br />fATHU - NAME fll
<br />
<br />Hall
<br />
<br />MIDDLE
<br />
<br />Grover
<br />
<br />Cleveland
<br />
<br />1.
<br />WAS DECEASED EVEI IN U.S. A....ED fOICES?
<br />IV.,. no. 01 ..."U I (II yn. Qi.... _0' ond dOl., 01 ..n;n)
<br />lB. No ------
<br />BURIAL. Cr.molion. R.moval OATE
<br />
<br />STAn
<br />
<br />
<br />5, 1988
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<br />2~. WestlawnMemorial Park 2~.Grand Island. Nebraska
<br />fUNUAl HOME - NAME AND ADD'ESS ,SlIIl1 01 It D, HO,. ,.,., 01 ''>WH. ,T,,", lIP, 68801
<br />
<br />n.Livin ston-Sondermann 505 West Koeni . Grand Island. Ne .
<br />DAn SIGNED (Mo. Do" Y,.) HOUI Of DEATH
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<br />~ . II .!ic: 'RONOUNCEDDEAO
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<br />~ AND ~ Of CUTlfIE SIC IAN, COIONEIt'S rHYSICIAN O' COUNTY AnOINEY) C~, ~
<br />a David R. Colan, M.D., P.O. Box 2339, Grand Island, NE 68802
<br />UGISTlAI DATE IECFlEa BY "WlSi~M... Do" Y'.}
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<br />260. (Signal...'.' ~ 26b,
<br />l1. I.....EDIATE CAUSE
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<br />DUE 10. 01 AS A CONSEQUENCE Of,
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