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<br />I
<br />
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATPS-l0 1675
<br />DEPARTMENT OF Hfu':LTH. IT CERTIFIES THE BELOW TO BE A TR,Ul}'."COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT)IP /imALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORy'Jro~.:
<br />VITAL RECORDS. . \
<br />
<br />jJ6.~JM'U "I A~~Jt,\~~;' .
<br />/J11f1UMJ/J.~Mr:~.-~:rc~,
<br />STANLEY S. .GQQ!ER_h!)~~~1'DR
<br />. BUREAU OF viiA{"&iAT'tS'i'~CS
<br />
<br />I
<br />
<br />DATE OF ISSUANCE
<br />NO'J a 3 t9e7
<br />
<br />LINCOLN, NEBRASKA
<br />
<br />-~,'" ...
<br />
<br />
<br />ClCIOEN1-N.u.tf
<br />
<br />flU
<br />
<br />SUTE Of NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH,S_ r:-
<br />MIOOU
<br />
<br />I. Gerald Wa ne
<br />IACt-(e.I.. W!.i... ...~ Aaerio:_ 0IIGIN/OEKEN1t....lto1i....-..,o..
<br />'..tie.. ....} U~<iI,1 0..-0.. ....1 fSp..i',1
<br />. White s.
<br />CI AND STAn Of IlttH (If -,.. l,/.SA.
<br />-- <<..-,)
<br />.. Grand Island
<br />SOClAl1ECUIITT NUMlEI
<br />
<br />leb Grand Island
<br />I.lSIDfHCE - '''''If COON"
<br />
<br />Hall
<br />1oU00lf
<br />
<br />lOo: Grand Island Cemeter
<br />fUNU41 HOMI NAME AND AOOIlSS
<br />
<br />Hahlweg
<br />tSJllIl 0.- ., D NO. on 01 lOw..... ,"u.n. ;UP)
<br />
<br />VirRinia Dr.-Grand Y~~R~d. NE.
<br />IlOC"'TlOH CITT Ot rOWN S1An
<br />
<br />>>:to .Grand Island. NE.
<br />,linn 01 I' l> NO. c'n 01 tOWN. S'AR 1"1
<br />
<br />fel-Butler-Geddes 1123 W.2nd. Grand Island, NE. 68801
<br />0'" 'G~ 1_ 00', r. J 10101,11 Of DEATH
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<br />i~; i (Mo. 00,. II,'
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<br />'HriICIAN 01 COUHff ..nOIHI'1 ",p. o. ,,,.11
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<br />,IONOUNCIO DIAOIH...I
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<br />N'~f.te~, Grand Island, NE. 68803
<br />o..n IfCIIVIO .. UGIUUI 11.1.0 . !la,. T,~'
<br />
<br />16b N OV 9 1987
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<br />bl~"'" ~"""'N1 01<<,." .114 ...."'-
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<br />T.. ~j ~o ~
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<br />w..., CUII/'IIIll> '0 ..IOI(A\
<br />flAMl.... 01 C~" J
<br />::"'" '" ~ N.J A ~
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<br />A.(ClotM'. 'UI(IOt. ~tOt. UN Of I . DAII Of ~"-IU" (w... D.,. P.. ,
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<br />CIIY 01 'OWH 5'"''
<br />
<br />Lot Twenty-one (21), in "Reutings Second
<br />Subdivision" being a part of the Southwest
<br />Quarter (SW~) of Section Twenty-four (24)
<br />in Township Eleven (11) North, Range
<br />Ten (10) West of the 6th P.M. I Hall
<br />County. Nebraska.
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