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<br />in Kernahan and Decker's Addition
<br />Hall County, Nebraska ~..
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<br />
<br />Lot One (-1),
<br />to the City of Grand
<br />
<br />Block Ten (10),
<br />Island,
<br />
<br />AUG 3 0 1985
<br />LINCOLN. NEBRASKA
<br />
<br />~..,
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THEN~~~STATE
<br />DEPARTMENT OF HEALTH. IT CERTIFIES THE BELOW~-~lPJ:.~'ECOPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STAT-E:-llEltAR"rMEN'J"?Of'HEALTH
<br />BUREAU OF VITAL STATISTICS. WHICH IS THE L~({Ai'I>EPOSI'f,Q&~OR
<br />
<br />:~::LO:E::::CE 200702189 ~1~ :
<br />sTAIln~f~i~Q~~TOR
<br />BUREA:P'~,i!t~:.sTATISTICS
<br />
<br />r,'
<br />
<br />-;'~;",-
<br />
<br />DECEDENT NAME
<br />
<br />'I15T
<br />
<br />STATE OF NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />'4b. Omaha, Nebraska
<br />RESIDENCE - STATE COUNTY
<br />
<br />
<br />""
<br />
<br />LAST
<br />
<br />I.
<br />RACE - (..ll" Whit., "aek, A.....;ean OIIGIN/DESCENT (.,ll..lIalian, ",..iean, AGE ~..... li..hdQ>
<br />Indian. ."'-1 (Sp.<ifr)
<br />4. White
<br />CITY AND STATE Of I'RTH"f nat jll U.S.A"
<br />"'(I~ coun',,)
<br />I Brainard
<br />SOCIAL SECURITY NUMIER
<br />
<br />RAY
<br />
<br />EDWARD
<br />
<br />
<br />150. Nebraska
<br />ATHER NA/o\E
<br />
<br />Hall
<br />
<br />MIDDLE
<br />
<br />NMI
<br />
<br />Rezac 17, Sophia UNI
<br />IN'OIlMANT ~ NAME -,tELA TlONSH,P ~ MAILING ADDRESS
<br />
<br />19.An eline Rezac-wife-14o
<br />CEMETERY OR CREMATORV NAAlE
<br />
<br />Maly
<br />(~TtUT Ot "'0, NO. C'TV 0'6000,!Alf. ll')
<br />
<br />Grand Island He.
<br />CITY O~ TOWN STATE
<br />
<br />Re.
<br />
<br />'"
<br />
<br />2 ,
<br />.EGI$TRAR
<br />
<br />26b,
<br />
<br />DATE RECEIVED IV UGISTRAR (Mo.. Do,. Y..)
<br />
<br />AUG 2 6 1985
<br />
<br />'''''rwal "'........ on.... 0...4 ct....
<br />
<br />a,.6~i'~ 1-1
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<br />tntttrval b.......~ 01'1"" Arid d~th
<br />
<br />/ '<<'0 ~
<br />Inhtn,oal b......." cwu... and d.-arh
<br />
<br />...tT Ill, " fE.....lf, W..~ THUf ..
<br />.tfGHANCT IN TNf '''ST 3 Ao\OHTN~l
<br />
<br />,)/{~1
<br />
<br />W..~ C"Sf tI'UtfO TO MfDlC..,
<br />fllUllNU Ot COtoNU
<br />($p."if, >;.. 0' No)
<br />29,
<br />
<br />.o.cCIOfNT. ~UlclDf, HOMIclDf~'UNDiT, '-',,1 O"T( Of iNJUiY"("M.., OQ",',',':-",'r "OUt Of INjun
<br />011 ~HDlHG INYUTlG..TION (5"..;1,) l1.,
<br />
<br />~~> .. T woai(' ~. --''l'L'Cf '0. !N~~Y ~-~ i;;;;-;;;.... t....... 3~,_
<br />($~Ur 'r.. 01 No) , off,c:. "uildio"V. M. (SPflif,J
<br />JOo.,_._~_______,"
<br />
<br />
<br />30<1.
<br />
<br />STtUT Ot t",O. H.,
<br />
<br />CITY 011 TOWN ST..n
<br />
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