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<br />!:l1 <br />2~;8_1 04014 <br />WHEN THIS COpy CAllIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARl'MENT ilF HEALTH, IT CERTIFIES THE BELOW TO 81:+ fTRUl!:.,CQPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT!OF'HEALTH <br />BUREAU OF VITAL STATISTICS. WHICH IS THE LEGALDEPOSlrpRYtFQR <br /> <br />VITAL RECORDS. l1i.JL...1. ~;;:""'. ~~.;;'ii.~~;~ <br />DATE OF ISSUANCE 1"~4,' .~/f.'!..r!:( , <br />JAN 2 8 1988 STANT.IEl'::~.',.(lO~ItIDi'~~~.~~CTOR <br />BUREAU 0'( 1'~rAF '~f:ATISTICS <br /> <br />Lot Two (2), Block Sixty-Nine (69), <br />Wheeler & Bennett 2nd Addition to <br />the City of Grand Island, Hall <br />County, Nebraska <br /> <br />LINCOLN, NEBRASKA <br /> <br /> <br />STATtllf' II[lIllSllA-DlPlIITlI[NT Of HUlTH <br />IUIIlU OF VITAL STATISTICS <br />CERTIFICATE OF DEATH _ <br /> <br />N -HAM( <br /> <br />... <br /> <br />IN''oe Cln LiMns <br />:::-~~'S.. He) <br />u- <br />Isaac <br /> <br />,'- Nebraska <br />A <br /> <br />Sarah <br /> <br />WAS otCII4IO fYI' IN u.~ ....0 fOIClI' <br />,,- _ .. -"11'......... - .-........ ___I <br />II No <br />IUIh&l. c,........ .......1 <br /> <br />fI'." 01 . , D NO. CfI'r 01 fOWtiI. "A'I. .I~ <br /> <br /> <br />16, 1988 <br /> <br />I. Ada Guy-W1fe-21S E. 14th-Grand Island, NE. 68801 <br />ClMlftel' 01 C"""'Oft - NAIll! Loc:.AftON em c.lOWN SfATI <br /> <br />rt <br /> <br /> <br />, "?S!J"(p <br /> <br />.. Wood River Cemetery <br />UHla&&. HOMI - HAMl .HD ADDlUi <br /> <br />_ Wood River, Nebraska <br />,".IT 011.' 0 MO. C'" 01 JOWN. If.rl. I.,. <br /> <br />2nd, Grand Island, NE. 68801 <br />,. " H <br /> <br />IJ., <br /> <br />t..... ,. " J <br /> <br />19RR <br /> <br />,.. 3: 15 <br /> <br />P. <br /> <br />I. 1>, <br />...~...................... -................ .............-...... <br />......u ..... <br />'......... ... ,....,... <br /> <br />... ,...,~.. <br />-- n. ...Of.." CAvil <br /> <br />-:.: Cardiac arrest <br />QUI 10. oe AI & CQNilQUINCI Of. <br /> <br />,.. lU~ cancer <br />0111 '0, AS A COMSIOUINCI 01. <br /> <br />. .................---........ <br /> <br />! ---.........-........ <br /> <br />.. <br /> <br /> <br />; 3 years <br />....... ........ -- ..... ... <br /> <br />k. <br />'... <br />. <br /> <br />em h serna <br /> <br />.T <br />,...~ '. - ~ <br /> <br />"An <br />