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<br />,.i :t-: <br /> <br />~~ flcPf' b <br /> <br />H,Fdn~.-:?rL- ~g:r- <br /> <br />H:!.!!!.~!!! <br /> <br />88_105507 <br /> <br />STATE or NElRASlCA ) <br />) IS. <br />COIllI'1T OF HALL ) <br /> <br />f/#/f'" Q ';1;J}<?N"7';;;~~./. after being first duly sworn on oath deposu <br /> <br /> <br />and says that be is a resident of Grand Island, Hall County, Nebraska and that <br /> <br />be is 1icenaed embalmer and funeral director in and by the State of Nebraska; <br /> <br /> <br />Tbat.r3~,.;~ .f j/?_'n/..~v_ , a resident of ,~,.,~,.,I . ../ /J/_~~ /]", <br /> <br /> <br />did die at .-i-"'Md'. J~/" or.#. r1 , >. on :1--/-, /:3 / 9~"';'- , and tha t he did <br /> <br /> <br />pl:'epare the body of ....?..-y....._.,~ .jJ jJ~...<LO...~/~_,... ,for burial on that date; <br /> <br /> <br />That, be did supervise the burial of the body of "q""",.:-.",f L_~"./.~ <br /> <br />ill hj,-r/J"?"''',-u (']~/~W?'); cemetery. located in ~""'_"'...",;.... d/1/~_"~ /"7..." <br /> <br /> <br />on :;:; ",~, /? ) 9c:--<-/ <br /> <br /> <br />That, ha did aee the d..d body of ~/.>'"N~~" _/ ,{ '...,~_N/"_U and <br /> <br /> <br />did positively identify sama; <br /> <br />Further affiant sayeth not, <br />Sisnad at Grand bland, Nebraska this ~ day of d,,;r,../~,~. 19.Jl:..l(. <br /> <br />~6YrrJ~ <br />A1'fiallt <br /> <br />Subacribed and aworn to before me, a notary public, this ~ day of ~, <br /> <br />19 n. <br /> <br />(4. li~.nql W,' , <br />~~M,l~,~~ :"~~_O~ <br /> <br />~~ <br />~~'Y ";;'0 <br /> <br />Hy caaaiaaion ezpires <br /> <br />.,5-.;(. 7'0 <br />