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<br /> <br />IDl' ruE (1) I BIDO< THIRIEEN (B), CIAUSSEN COlNTRY VIEN ADDITIlli <br />'IO '!HE CI'lY OF GRAND ISI1IND, HALL muNT'l, NEBRASKA. <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A T~UE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS. WHICH IS THE LEGAL D~OSl'IORY FOa <br />VITAL RECORDS. <br /> <br />DATE OF ISSUANCE <br />JUl 7 1988 <br /> <br />~'...J'.',,~' ,.~,'~,., <br />~ ~ " , <br />, . <br />..' '"'.. -., .-. l' " ............."."..~ : ,'^< <br />STANLEY S.' OOOf~R" :bi.RiOTQR <br /> <br />;.~, . . , . ." /, . <br />BUREAU OF VITAL STA~~STICS <br /> <br />LINCOLN. NEBRASKA <br /> <br />88 04868 <br /> <br />OfC!D!NT NAMf <br /> <br />f1UT <br /> <br />MI <br /> <br />Hall <br /> <br />Vine <br /> <br />"" <br /> <br />~ <br />\ <br />..... <br />o <br />CJ.:l <br />-..1 <br />..... <br />CO <br /> <br />NMN <br /> <br />Herman Unknown <br />IN.OIMANT - NAMf -IfLATlONSHI' - MAILING ADDRESS <br /> <br />Unknown <br />(STn" 01 I.' D. NO.. CIT'r 01 TOWN. STA'l. lIP) <br /> <br /> <br />20., Westlawn Memorial Park 2DcI, Grand Island <br />.UNE....l HOM! NAMf AND ADORns {5TIII' 01 ','D, NO.. c'n 01 TOWN. 5''''1. liP! <br /> <br />19,David Husman Son 3862 W. Tufts Ave. Denver Colo. 80236 <br />CIMETER' OR CREMATOIlT NAME lOCATION CITY 011 TOWN STAT\! <br /> <br />2Livin <br /> <br />D!ATH <br /> <br />Nebraska <br />68801 <br />Ne. <br /> <br />ars. <br /> <br />:~~-_..... <br /> <br />: unknown <br />! lo_____ <br />, <br /> <br />{~l <br />DU! TO. 011 AS A CONSeQUeNCe 0., <br /> <br />, <br />l ....................-4... <br /> <br />, <br /> <br /> <br />lei <br />,.0.1' " <br />II <br /> <br />HI ICAN' C_DITlONI- C....I_ ......~..... .. 4..'h ~I ... ........ ~:c\:r.~~~Ji r.r. ~=fll5f <br /> <br />ACClDl",. IUlCIDI. _CIDI. UHDI', DATI Of INjun ,_, 0.,. r., <br />011 "H_ IHVlITlGATlOH tJ,...I'r' <br />... suicide *,.4/12-,~/88 <br />IMIUIY .., wc* ttACl Of INJU - M . .... -. "....... <br />,.....'" roo oo "'1 0111.. ki...... OIl, II..,,' <br />No ~.Home <br /> <br />S. Vine, Grand Island, NE <br /> <br />CII\' 011_ "..n <br />