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200709882 Lots One (1), Two (2), Three (3)and Four (4), Block Four (4) ,Fifth Addition to the Village of Cairo, Hall County, Nebraska. STATE OF NEBRASKA WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM IT CERTIFIES THE BELOW TO BE A TRUE COPY Or THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS :~:~::~::;TORY FOR;; ~E;O~;. 88 2 ~~~~~ER NO V 0 8 2007 AsSlsTA~f"~~f€ R~i~11 LINCOLN, NEBRASKA HEALJ:H f1ND HUII44tJS~IC!!S STATE OF NEBRASKA - DEPAA'TIIENT OF HEAL ni :" r' i"'{ ,. t(9 4 "" 0 2 3 8 8 C~~~~ICA':ELO~ADE:TH '::) ~\ t ~ Jr. AD' : ~ ~'~ ~ , t.;;ce~.... ~ FIAST MlODI..E IA~T Florence "" CIIYAN()STATEOFBlATH :'"."W.SA.__J Schweitzer 50- AGE -l..Ool"""'; UNOI;R , VEAR IY",) 51>. lAOS DAVS Wood River Nebraska 7. SOCIAl SECUIlTIY NliMllER 79 .. FACl.Il'V-_ (lltItJt_fJiw__.-, ea. PI..lCE OF IlE4TH ~!T~ 6a:--- DER~ DDOA OTHER: o ~1Ong- o A<-. o ON!' (StN<;"t1 505-70-8199 St. Francis Medical Center k errv. TOWN OR I.OCAT"'" Of MAW I~ZfJ~ eo ~CITY I.MT$ ed. ~SIOE CITY LlMlTS 80. COUNTY OF OEIITH Grand Island !lI. Ile . stAre ] ... COlMtY Nebraska Hall Cairo 'Q AAC,E.104- _ _. ""'-<an _ f' AM:E$TRY I..;.. _. -..... _. ""'I *-1 ~ L ISI>o<oIyl \ 0 White German' ..... USUAI.OCClIPATION lONe_d_t1tJtIeN/tlfl_ 1<11> K""OF_SSIlWUSTRY ""-""'11--'_ f) .t H~usewife'\\\ I 16. FlITI1ER. _ l'JIST IMllIllE Domestic LAST ]'7 UOlHEFI Stutzman Rena J: ~fORlWlr .1WlE . Harold Schweitzer ,STREET OOIl.F.D.I<O.. CITY 011 TOWN. ST^TE. ZIP) Harold Schweitzer I 5. EllI.JCA T1(lIj ISooooIy only ho;l.- ",ado 0QIIIllI0I0dI Elemoo1Iooy..SOcoo1de!y 10.'21 Cc:Iol!" /1-4..501 8 . MlOOl.E MAlOl;N 8URIAIE Daniel 'P 'ti~ ~ EVER ~ us. _0 FOIlCfS? .;0......-:-1 i 1'- __wi_"'_' .1lI>. ~1 UAlUNGADDAE$S Stutzman 22a. 117 Cairo NE. 68824 7;' '] 21.. IIETHOII OF DlSl'OS1TiON KXIlurIal 0-.. 2'1>- DATE 210 CEMETEflY OF! CAEMATOIIV _ STATE A fel Funeral Z1h FUNaW.1IOUE ADDReSS Cairo NE Wood River NE 68883-12~ 23. _TE~ leiTERONlYONECAUSEPERUNEFOR,oJ.lbJ.ANOlon ~ . ~ J 1,., ~"",,-,"--c.~ ().~~ DuE 10, 011 M ^ CONSEQUENCE OF' ~r:: ........--...- lI>l DUE TO. OR.AS A COOSEOuENCE Of, -'''__and_ 101 I Ol>tli'R SlGNIFlCN<T CONlllT;c)NS. or-.. -.0 "'....- !IllI...._ ~ARl .. I. FEIoIALE. WAS THEIlE A I" AUTOf'Sv d"" WM CI\SE Ra'ERRED TO MaIICAl PART _G"Imo~Y IN THE PAST 3 MClNTHS' EXAMN:R OR 00ll0NEfl? · lAg., 'O'~I~_~~ Y.. n ... v.. n No~ _. 261>. ClATE OF lNJUFIY ,Mo. o.1t. Yr.! i 211< HOUR OF......'fIY , 2M. OESCAillt' HOW IIU!llV OCCURRED O-Ou- I M I o Su<:... 0 ~ ~ ;;;jii~Jw ~~~ if.W,'t' ,*,m ..... IM:toIy l:>rig. Lor..ATiON LO _odo - L y..D...O I _~_'+__~'~~_~'_I r 27.. OATf Of OEATti ,,,*,.0..-, Yt.) " t M"_ - ~ "' - -~-~ E 2.. I '/'fi I>~' .. I~" 27b.OATESlGNED ,"".o..Y'1 ..12-rdIME0F0EA1'>i. '--il{~~ 2lI<I'ROIiOUHCEO-~-""".r;j111l<lf'R()lO(llJNCEDOEAO ""'- t,g 'l.. /1 g J 2.i-~._--~.' D ~. .-4~ I a i i! ________.__----1- .. ~.J 27d. TO...lIIlIIoI""I~~~....ilIo-..,.."""o;.d> ...."'... l...l( d '* (:>>...._"'....--._'OI_......__~.. ... ~.I-. 7 // /f"'i ' ,', <. ~ ..-.--.................<-- P'" .' I .... '/ I I I~.~__. ~_I:::::::_. .._..___ isv--o_tolelll>_. I". OIOTOllACCOUSl'CQIIT-.JTE TOtHl' DEATH? . I"- 130.. HAS OI'IOAN OR ltSSUE ~TlONIlfENCOMiIlERl'l)? T:tlb WASCON!IEN1 ~ l 0 VEsfitNO D UNlNt1Ml .L__.__ 0 v:~_~_~_._ _~J__.__.___o ~_-'-~ NO 11. _ A>IO AOOAE5S Of' CERTIFIER IPHYSICtAN, CORONEl> 5 ....'SIClAN ()A tOUHTY A nORNf:Y, I TIf>' '" """" STllEE"T OIl RF.O. NO CITV O>l TOWN STAn 'ir.AiiiffiW;-' Custer Avo, Grand Island, Nebraska 68883 ---.---- I3:!llPAT1'-..:EO'avl\allST_ .. Do,> "'. --_.__~--1 FE@. 2 3 ~___~_.