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<br />LEGAL DESCRIPTION
<br />
<br />Lot Thirteen (13) in Block Two (2) in Knickrehm Second Addition to the City of Grand Island, Hall
<br />County, Nebraska
<br />
<br />STATE OF NEBRASKA
<br />
<br />200800601
<br />
<br />1.
<br />
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEAL TH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEAL TH AND HUMAN SERVICES, VITAL RECORDS
<br />::;::F~:::::::HE LEGAL DEPOSITORY FOR VITAL RECORDS. NIAt'. rtn J,~. ....... .'
<br />
<br />{~~COOPE.R.
<br />UAli 1 7 "OOQ ASSIS1:A1tJt STAf-Eft.ffiISTRAR
<br />., I~ t. u bEPARTMEN7:..on4eiLTH AND
<br />LINCOLN, NEBRASKA HUMAN SERVIC~S' :~_ "
<br />-. " r- ^i :.
<br />~. J'LcL-'....
<br />srATlClFNIIl&ASKA-bllP.U:::IaINTorHiAL1HANDRUMAN_VICI!SPlNANCsAllD~ ': '1"
<br />VlTALSTATJmC8 ,. '. /,.ul Q51. 5
<br />CERTlFlCA1EOfDEATII ':< <,........... ~ ~
<br />.....s' . SEll 13 ""'II!<l1'Il"-""_OOy.Y~ .
<br />Lanka Male Ma t;'200-r
<br />5lLA(ll;.Le_ UNOfIllVU!l UIlDER10AV 1i00l'E0f1lRlH _ ._
<br />_. 51>. MC)$. D/lVS 50. -; I.lItlS Ma 2..(-191 3
<br />
<br />C'tHt~ 0 ~H.~
<br />iJ -.-...
<br />o 00..''''''''''''
<br />
<br />.-
<br />
<br />I'IR5T
<br />
<br />_e
<br />
<br />William
<br />
<br />NMN
<br />
<br />
<br />.. C!TYANll$TA'ltC!l'lliRTl! 1II",,"li$A..__'
<br />
<br />St. Paul, Nebraska
<br />7. llOCIIIi. SlWRl1Y .....R
<br />
<br />505-22-8646
<br />
<br />..fAC!UT\'........
<br />
<br />(11""_ g;.-_lII4f1U!1OJ1/
<br />
<br />212 W. 21st st.
<br />
<br />.~--------..-.:..-.
<br />
<br />.... CITY. 7(lWN Oft ~oc..'llON Of OP1It
<br />
<br />Grand Island
<br />.IIt.RE .STTE
<br />
<br />_e
<br />
<br />Own Gara e
<br />
<br />lAST L~ ;:a
<br />
<br />i9a. IN~.NAMf
<br />
<br />i 15 fOO;"1OI '--"9'MI9'""I!"""'-
<br />~ ~CIr~IO-;~ ~11.y5.1
<br />
<br />flAST MI(lOI.f lI.OIM1< Sl._
<br />
<br />Charles
<br />
<br />18. WAS DECEAliED E\lEfllN u.s. _0 F. 7
<br />lV""-Yol 1....._---01_
<br />
<br />Lanka
<br />
<br />Ambrose
<br />
<br />Bessie Lanka
<br />
<br />1... lNF<)I;IWIY
<br />
<br />.....- .l>DRE$S
<br />
<br />.S,<l(ET DR R.F 0.1.10., CITY OIl TOWN. $r A TE. ~Pl
<br />
<br />212 W. 21st St. Grand Island, NE 68801
<br />2O.fUIIAI.IlItR.SlGWiT1JRl!& IlD ~l.Mif~~'T1DN Zl~.O^TE Z1c CEi.tfTl:RvDRC"\:....'OI'v ~~emation
<br />Not Embalmed. I D- 0-., Ma entral NebraSka
<br />
<br />&F;:;~=_Greenway ~~~:ral,r::ic-- Dlloool'" 121~~:C~U;:~~:ka .-;;.~~---;ym-
<br />
<br />I Z2b. FUM_ HOME AODAESS ISTIlEETOR RFO. NO. CITY OR ~ lIP;
<br />411 "0" St. st. Paul NE 68873
<br />23. ~l'ECAU IENTERDNLVDNECAU!'lEI'!:RLlNEFOR'" '01.A11Dle" _..""-....__
<br />p-
<br />I la, Natural causes unknown
<br />DUf TO. ORASA WNSIOOlRNa 01' ...... _......._
<br />
<br />IbJ
<br />DUE TO. DR AS. COI.ISEOIJ/iNCE Of
<br />
<br />~~~iIr'e'~
<br />
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<br />
<br />I ltl
<br />f M'Vllm'-"-=i'3'~~"""-"''''''- 'PARTI,IFFEMAU!.WASTHI;REA ---I?t A(j~V . rw-:~CA",Ib.t;._..lOlEl&foI.
<br />PAEGNANCVIN THE PAST 3 IMJf<lHS7. 1 I U_AOIl~'
<br />1_ '0-0" v.. n No 0 '. Yo> n "" 00 I '" Dr! NO 0
<br />j!& " i 26b GATE OF INJURV '''''~. a;".. m i 26c ><<)UR OF II<J1jRV 08<1. OE6C~ISE HO'\""'JU"Y OCo:uMEO
<br />
<br />,D--Ou,-- 'M
<br />C s.""... 0 __ 260....'VRV.'W01'l\ llef ~~~Vi=.I-'''''''1O<lO<V ;oeg LtlCA'I''''' -$l"f.€tOfH,fDNO
<br />o ..,..,.".. "'- Vl3 D No D L-
<br />
<br />· OA'EOl'~'IH 1.110 Qr.. YO 'I 2llI DAT~SIG; '7';.' lltO TII/I:OFD<.ll.. approx
<br />
<br />"'~ _ ",~i I ( ( !_J_..J!L_~_I- 5 :,90 am ..
<br />I.... 2",~ OATo - ,"" 0., Y" ,~7< ....... Of' DEATH j i ~ .. ~~'D ...", ,.., uo,. YlI I ~ PIlD"'J<)/'OG~" DEAl> "~,,
<br />
<br />}fg I -4~iPIUay 6. 2 'i 9:45 am II
<br />.~ v~ lO"'b.-Of""I(~",dMf1occU".._"'dM~C&lct:"'ouel('''' 2ilu 1211 onf\t~ot..~ Of ~LlfMttI
<br />(;.I&M('Jl"" l..~ ~ -.. "~,",-.~W1G~ 10
<br />~nlT"j. .....TOIo
<br />12ll 00 TGeA.XOUSE COO""'E TC'Hf. OiAT~ ,30. ...sOAGANa'H1Ssuu'O....11OH se."'C-...'.<SIOI:I'EO'
<br />o YE$ 0 NO [j l.iHKNOoNN I 0 <ES [Xl NO
<br />,
<br />'I~' NMEIMOADDIIP.:5SO!"CfmWICR !""''''~.~IilISptlY!J'CW'4~COUPaY''tl()R'WE1, ii~()tf1'r",
<br />
<br />I~_~t: D Osterman. GIPD. ]~OJf~rand Islan.d. NE 6ll.8.lll.
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