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<br />88_101649 <br /> <br />'\mEN 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 DEPARTME~~, 'OF,'llI1.A.LTH <br />BUREAU OF VITAL STATISTICS. WHICH IS THE LEGAL DEPOSITOJ;l..Y,~m~ <br />VITAL RECORDS. ,. <br /> <br />~l~ <br />STANLEY S. COOPER, DIRECTOR <br />BUREAU OF VITAL STATISTICS <br /> <br />I <br /> <br />DATE OF ISSUANCE <br />MAY 1 9 1986 <br /> <br />LINCOLN, NEBRASKA <br /> <br />STAll Of NEUASICA-Df'AJmIINT Of HEALTH <br />BUREAU Of VITAl STATISTICS _._ <br />CERTIFICATE OF DEATH ',. ").: <br /> <br />85 14488 <br /> <br /> <br />MeiDl"' - HAMf <br /> <br />flU' <br /> <br />10\1 f <br /> <br />lAS, <br /> <br />DATI Of DfA'H (Mo.. Da,. 'f"J <br /> <br />frederi:th <br /> <br />he <br /> <br />..... Grand Island <br />MSIOlNCI-STATI COUN" <br /> <br /> <br />ISlo. <br /> <br />202 <br /> <br />MIDOlf <br /> <br />. ... Walker r. <br />~ WAS MCIAIID MI... u.s. .....D fOIClSl <br />fI'_ -. _ "'11'. ~ .. -..ef....... .. ~..) <br />II, yes lI.orea 1951 - 54 <br />IUIIAL C__.-'-' <br /> <br />Smith Sr. Grace <br />INfO..."" - NAMI -IfLUIONSHIP-MAllING .1.00">> <br /> <br /> <br />.,. Barbara Smi th Jr. wi fe - RRZ Box 202 W <br />CIMIlIn 01 CllMA'on ..._, lOCA'ION <br /> <br />D. Jensen <br />(Sfnn oe I.'.D. NO. CITY oe toWN. "All. ,,,, <br />8883 <br /> <br /> <br />... <br /> <br />200. Lincoln Memorial Cremator Lincoln Ne <br />fUNDAl MOMI- NAMI AHD ADDIIfS5 ,5f1lf1t oe I '.D NO.. CI" OIlOWN. srAn. ZIp) <br /> <br />Wood River Nebr 68883 <br />HOOI DIA'" <br /> <br />2.~. M <br />I'IONOUNCID MADrN_,) <br /> <br />Av. Grand <br /> <br />r <br />... r;......., · , <br />.:.:.OlIdA~~p A1 ~ <br /> <br />, . .000ASA~ <br /> <br />(Me,. 0.,.. ",.' <br /> <br />DEe 3 0 1985 <br /> <br />: ----- <br />: 5~ <br />1........ - --- <br />: 2-~_ <br />. ........ - --- <br />. <br />. <br />. <br /> <br />--14 . <br />,Aft <br />. <br /> <br /> <br />~T W&lCASl_ft)~ <br />r.-OI c-..I <br />~;Ip 'oo .. ..., <br />19. <br /> <br />... <br /> <br />__ 01...... _ <br /> <br />cmoe_ nAg <br /> <br />L <br /> <br />--.J <br /> <br />L <br />