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<br />Recorder's Memo: The N 60' of Lot 3 and the S 20' of Lot 4 in Imperial Village Second Subdivision, City
<br />of Grand Island, Hall County, Nebraska
<br />
<br />~..,
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMMi$ERVfC;E$
<br />SYSTEM,IT CERnFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REr<!~qji~~/TH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTlt:8.BEC'I'If1Ni~/S
<br />
<br />:~::~:::::~TORY FOR VITAL RECORDS. -'t.:';'if'~7!4>~"~{,.
<br />MAY 9 2000 ~_uo_,;
<br />2 0 0 7 0 7 4 9 2 ASSI$.tMtr ffA tl! ItEcjl$T~P
<br />LINCOLN, NEBRASKA HEAL TH AND HiJMAN.SEWACE~,~)$Tt!!'f
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SEk~l;gs fINANCE:~iitwPORT
<br />VITAL STATISTICS --""3.,,_~"'2'-~'-
<br />CERTIFICA TE OF DEA TH-
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<br />I: r.'f' .e"FN[ "^M'.
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<br />3 D^ f[ ()t- OEA fH .'M"ll'lr~ (\1, 1"(~,1{1
<br />
<br />Richard
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<br />w.
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<br />Becker
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<br />[3St RIr1M(ly L~_f:~ 1."YFMl
<br />~ib MOS I DAYS
<br />63 I
<br />
<br />Male
<br />U_.-"UNOiH""1"-6A Y
<br />5c HOURS MINS
<br />
<br />April 28, 2000
<br />6. DATEOf.o'if=ii.;'('" ,MonthOnV h~nrJ
<br />
<br />crlv ANDSTATF OF AlnTH IInolln U" , ~'dm",:-un",. - -L-AGF
<br />(Yr:i I
<br />Grand Island, Nebraska
<br />-- --- ---
<br />
<br />
<br />November 1, 1936
<br />
<br />I SOCIAL. SE:CLJR1IY NUMRFR
<br />
<br />507-36-3164 HOSPITAL [KJ Inpallen>
<br />
<br />ffi~;:~-I-TY F:: nc i ~- -~:::': ~~~'~ :~':':";' '''''''be<I-----j E~ ~)~~)"'pa".n>
<br />AI (I""TOWN oRw6:iiONor DEATii--- - -------- - -. --'l~NSiD~TY-L'fMiis' 'lBo-'COUNT Y OF OFA TH
<br />'..Grand Ii31and -- _____.1_ Ye, tXJ No Or Hall
<br />I:;S;:N:E:::T~=-r C;:T~ 1 9~::~~WN ~R:~:l:~ 9d STREET AND NUM::~,:::q;" c;; 8 0 3 "" ~::'D~]rVN:,i'~l
<br />
<br />10 f1ACF. (c,g.. White, 1I1<'iC~ I\rilt':rrCar) Irldln/1 11 ANCESTRY Ie g Italian. MC~lc~a~.,'GB;~n~;\'~!;"""'''.'..'~~'F [XIo-n_--NM:.vRE'R'RIED 1 J~"N.AME.-OF'.s'rOUSE ilf wile .q1ve
<br /> m,l!dl~IJ name)
<br />f!le I 1'::)Dt.}l::ilYI fSp!-!clty! I : c-
<br />_ ,~hg e Ame r 1,S.9:!l____,__ __ ____ I MARRfEO _.~=~-=~l ~~ e V 0 r--=-___________
<br />14,1 USUAL OCCUI-'A liON lei/vI':' /.'"/fld(J! w(JrA (tone d/Jflng most ~140 KIND OF 6.LJSIN~~S INDUS 1 RY t:. CDUCA nON ISpe(:lfy onlv I"lIghe51 gf~,?~ comp~~~~__
<br />of worl!'lnt) life, ~~lIen d ,'Mlrer.! Flf:!rTH;!nl,Jr\l Or SeCO(\dclr~ '0 ' 21 COlleqt-.' " t ll'
<br />Salesperson Agriculture __J.__.m 11
<br />1G ~A1HE:R. NAMF FIRST MIDDLe r. -~ LMn .-----.~ 17 MOTHeR FIRST
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<br />N1Jf5lnq HOf'le
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<br />Otnel' (SpI'('
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<br />MIODl F
<br />
<br />MAIDEN SURN^ME
<br />
<br />Edward ~:MN
<br />
<br />Becker
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<br />_~reg~da __ NM~__
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<br />Sack
<br />
<br />1il WA~, Jt:Cf:.ASED EVrR IN iJ~ ARMf:O F()RCE::..l
<br />iY!~s ~'I() or Liflk I 1 'Ii ve~ q:\Ie '0.;<11' and C'<1~1}~', ~~~ ~::J'JI(:'~"I
<br />'l___N/A___.l_____----=-=-_ ___._____~everly Be<:ker ____._.__.~~_____
<br />119b INf-ORMANT MAILING AoonESS ISHH:tT Of.\ i=U= LJ NO. CITY OR TOWN STATE. ZIP)
<br />
<br />i?O~: ;R5 SIGNA TLI : ~_~_f-_O ~k '_'_ _G.;_a;t I s 1~~ ~~;OD ~ :~D~I~D~ k~'b D~T~ 8 0 3 '-""-'.-T~TFRY OR CREMA lOP' NAME---------
<br />-j'" t4'; -v-~. _ _ [XJ Bu".1 0 Rem,,,,1 Ma 1, 200Q___J WestJ:~~~__ Memorial Park _
<br />122~~):F~:gS t;:~Sondermann F. H. D C"m,,'Oo D 000"'00 21d cEMETERYORCREMA1~R~::A~oNIS landCIT' on T;~brask:,q
<br />
<br />~~;~~~~~~~::~b =~.;:~~:o~,;:~~~:':~;":;.;"~,~:~,~~- .~=--T'""~~~","";~
<br />~: P~R':~"E TO OR AS A cON~lt!or~A./- (~- _______c. f~~d~[,,, ",,'"
<br />~- -Cl1t1.c_~_IJ_ _ ____~~_
<br />DUF.: TO O""'nJ,~ It CONSUlULNU.': or Inle;'o'<':III,efween Qn!'>/~l ,"I~" ,.;,~,ll'
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<br />1~------'-lTHF.i"Sir.NIFIC'NT CON6iT'ONS ,;o;;;;;;,,,,;-o.;;;'bulooq '0 Ihe rleath h,,1 001 ,.fateo PART IfllF FFMAlf W'S THERE A ~Urcii's;--- ~ ,is' W-A'; CAS, R'-e'-Rf';:r~lI )-,'-Fi.,c
<br /> 'I
<br />, ^'" PREGNANCy IN TH> PA',I J MONIHS n 1'\", Xl "xaMINb' OR COR"~' "ixt
<br />" _____--------__.~ _______ ___ _ J ~~5'Q.,41 _ ~~_O___~~D_ ~~,fl_~~) '\ ~D____~__'..=.
<br />Acc.d!:!nt [Uj U"".,.",,,,,." i ',;h f_~T~~_'=': 1M" V<iy Y'J ~^' HO"R OF IN "'~____~_.J~r:_:eS( RIRe HOW INJIIPY OCCIIR, cC ______ ______________m
<br />
<br />
<br />~;I)IGl(jC P'~.r'dlr"II.~ ,.~fj(,.' IN.!\J'"lY AT V/()RK I 261 PLACE OflNJUHy . At h{)rT1~ 1<l.'~T' :ill!:!el la.CIOty 2Gq L()CA nON Sl~f:.t T ()R f4 F- 0 1\10 ::XTy OR TOWN 1 T" I
<br />I oHICf:! bUilding, elc /Sf)eClfy)
<br />i
<br />
<br />1 gi-l INf-ORMANT NAMf
<br />
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<br />_ __ __ ...L._____ _ . ___________
<br />I\a UAI'-UeO'-AIH Mo 0" "I T
<br />
<br />,'; ~,. tI.. J't --Or) I ~ ~ ~
<br />~ t i I~; DW SIGNErM: I~V~lo - ---lffIME~3-~--" ----4- - --11 H! i
<br />
<br />~ ~ ~~!t)~tJe~i my kn~)~If!-;:1(ifl c1 rh -( ~;1;m;I~ e li/-;;'-rPll1.';;;duelo-;;::;; --~" ~ ~ ~
<br />t.lli '::;::IlJ~elsl stated r. ~ '
<br />
<br />: 2WD1 To~~t~J;=:~~)~lD:~I~lJN1~u_ 10.. H."[)F,rH' - ~T~;HASnRGANORTi5su'D+iNAiiON-BEf
<br />I'\, YES 0 UNKNOWN ~ DYES
<br />
<br />X ""-. mo ~o> ~Zffi"",:";, =71"~'r;;';;]^TI~'" '";il
<br />"" ">",-" .~. Cw,-
<br />
<br />28(1 [)A H: SIGNED iMo Dav }I, I
<br />
<br />T28b' 'i~M-~'b~' OEA1H
<br />
<br />r~l)rrllClclc
<br />
<br />11'~v...:,~,!;q;.llI01',
<br />
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<br />
<br />28c PRONOUNCED DEAD (Mo, Day, VI)
<br />
<br />286 PAONOUNCI:-:() UfALl {Ho/ir!
<br />
<br />M
<br />
<br />28e On Ihe oasis of exarYllna\lon af"1Q Of irwestlgallon. 1(1 my Opinion r:lf!<-Ittl oc:curre.;j <:II
<br />the time, dais and plal;:e and dlJ~ to the (:r.lu!'ip.ls) staled
<br />
<br />
<br />30,b WAS CONSENT GRANTED'I
<br />
<br />X
<br />
<br />A/r; ~I'n(
<br />_ _r~____
<br />
<br />D IES ~NO
<br />
<br />J C4..v~ .1..{
<br />
<br />
<br />DATE; Fit ED BY Rf1Vi~y {Mo D~ Yf2000
<br />
<br />t;MA/4
<br />
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