|
<br />I
<br />
<br />WHEN THIS COPY CARRIES TilE RA ISED SEAL OF TilE N~;';;: s!~ 18 78
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COpy
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE PEPARTM~,>>(JF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOS'tTORY'. FOR
<br />VITAL RECORDS.
<br />
<br />"I
<br />
<br />JAN 1 2 1988
<br />LINCOLN, NEBRASKA
<br />
<br />..,. :, "," "- '::.
<br />
<br />A. :J:~"";"
<br />. . ',. ~.. .: ~~..,. :" '
<br />. - .
<br />STANLEY~:S. COOPER~:'"D~ECTOR
<br />
<br />, -, ~. :..~ ....... I. ,.-,. '. o,;~
<br />BUREAU OR,' vtt'U'; STA1'ISTICS
<br />
<br />DATE OF ISSUANCE
<br />
<br />Of eDENT H.u.lE
<br />
<br />
<br />fiRS
<br />
<br />STATE Of NEBRASKA-DEPARTMENT Of HEALTH
<br />BUREAU Of VITAl STATISTICS ,
<br />CERTIFICATE OF DEATH H -j;j
<br />"'" UK DA E
<br />
<br />!iOCIAL S!CUIITY NUM".
<br />
<br />1 Louie NMN
<br />~WA' DECeASED IVEI IN \.1.5. AlIlltD fOacfS?
<br />(rift.. .... .. ,,.,.) I {If ,.,. 9i.. -c.t .N1 ,..... .1 ",,...I"}
<br />11. NO ------
<br />
<br />IU.iAL. Cr.JIIlGtion. 1.1I'I<rPO'
<br />
<br />Hansen Alma NMN
<br />INfOUolANT - HAME - .flAlIOH~Hlr - _'UNG ADOlt~
<br />
<br />Christensen
<br />II,.ln 01 II D NO.. Cln 'lIe:S(~Hs,..tI. IIPl
<br />
<br />
<br />Rt . f1l Eox 417
<br />LOCATION
<br />
<br />Grand Island
<br />CITY OIIOWN
<br />
<br />Ne.
<br />SlATE
<br />
<br />2Ot.Westlawn Memorial Park 2Od. Grand Island Nebraska
<br />'UNEIAL 110000t NAME AHD ADDlItSS I"lfll O' U D NO. e'n o. TO..... "loTI. ZIP. 68801
<br />
<br />1~ivin ston-Sondermann 505 West Koeni . Grand Island, Ne.
<br />DA E I NED (Mo. Oor, Yd HOUIOf DEAHl
<br />
<br />~~ti
<br />i~~ 1_0
<br />
<br />-!.!:5", rllONOUNCfD DEAD PRONOUNCED DEAD (Hov')
<br />
<br />s..t 1 (M<I.. Oor. Y..)
<br />
<br />'" V~% 1-..
<br />
<br />J~8 0.. ..~. .1............. .HI-- HI....."'.ti_. i. _, opifti_ ...'" OO;:f.vn_d at
<br />:'8~ .... ti_. tIcrt. .M11 plMe cu.... .......... caw_h)..1GttId
<br />
<br />u 24t1_.s.....GfIllI'Q .fKI ri"., ....
<br />
<br />AnOINfY) tfrpe Dr 'tin-U
<br />
<br />2_b.
<br />
<br />M
<br />
<br />/
<br />9;E
<br />
<br />In,,*,,-~ 1Iit.......... ....... a..... chotlo
<br />
<br />J
<br />
<br />/ N~ lA
<br />I..,,"",~ ,,~ ..... OM .,...
<br />
<br />l<l
<br />,All
<br />II
<br />
<br />ACCIDlNt. 'UOODl. HOOOICIDt. ....DlI, Dl>.TI Of ,NJutr,_.. D.,. r. ·
<br />C>> H_ _'TlGATION U_"".
<br />
<br />30..
<br />INI.... Al wo-
<br />,I,..ifr ,_ _ ,..,
<br />
<br />:IOd.
<br />
<br />It. IT 01 I.f 0 Me.
<br />
<br />Cln C>> TOWN StAU
<br />
<br />)00.
<br />
<br />L
<br />
<br />~
<br />
<br />L
<br />
|