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<br />Please record the attached Death Certificate on the following
<br />
<br />1. Lot 19 in Block 22, Original Town in Wood River Village, Hall County, Nebraska; and
<br />2. Lots 5 and 6 in Block 22, Original Town in Wood River ViI~ag~.~all County, Nebraska.
<br />
<br />STATE OF NEBRASKA
<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 SERV!CES,VJT.t!o4RJfCORDS
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS, ::if:;';.i";
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<br />DA TE OFISSUANCE 4. '
<br />
<br />DEe 1 8 2007
<br />
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<br />LINCOLN, NEBRASKA
<br />
<br />200802393
<br />
<br />ITATI OF NeIIRAPA -DEPARTMENT Of ....TH
<br />.......u bF VlTAL8TA11I11Cle
<br />CElmFlcATE OF DEATH
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<br />Maria Narcissa Ro'as
<br />.. ci'iVMiD8iAn: ClI' ..'" . 111_" w..... _..-... ... AQ( . Uol lilt... I
<br />. Omaha Nebraska ...: 6O_~=-L""" "-,
<br />7. soaAl. SCUWiY ~ -----,e., ......(;1" OF DEATH
<br />5OS-52-3643 I !!:!i!E!W,;*_ lUla bJ__
<br />...F4ClIJ"._---..;;.~...___, ~ OI'R~ D_
<br />. ~.!. Fnglcis Skilled Care Unit ~ _ ~..:.-.. 0 P<J#, _.______ 0 0tll0I_~-l'J---~-~-~-.
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<br />'10 _r.{. 'ITATE -- ... CllUlliY--'--'--ik'CiTY-. Ill. 0" I.OC/lT~ 10. SOUl AIlO_ I...... c";;- 110 .-c.IY~
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<br />I Nebraska Hall__.____l Wood Rly.~L ___.__ I 0' BO.!.-444,J1O E. 9th 68883 -L. y..1Xl No 0
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<br />'. .' _.~._~____ U:o_ Ol,:,,"aO Fau~toT. Roias .____.._____~
<br />T...USUAlU':CUPATION'I__oI__"""_ ." '....IINDOfIlllHlfSS!lolOUS11IY . r:f\.I..!LiQ\IJ;L~~...!l!llY~~!WL____
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<br />18....""8........ F'NST ~IOOU iAJl I" MOTttl.1I 011I9' _f "WD9<SUIINMIF
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<br />Zenon . Rivera Sr. I
<br />1l~U.sroiVt"W uuiMi) fQHli8.,-----~---~'s;:r.Fii-l OlAMr--------
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<br />i 7111I. "S=OIlMAf&T MAtl~~ "WAf" ISTMU oA fU l1. f'1IO'. CI1Y OF.! to-.. Sf A It. 1"1
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<br />k P.O. Box 444, 210 E. 9th Wood River NE. 68883 n__ __
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<br />: ~~ HOM/;.Ol4M( ~ t-;;;; ("~","YO~CII""""""""GAT1ON CIlVOllm_ sI..n
<br />i Anfel Funeral Home [J er......." ;~'] .-....1 Wood Rivet' Nebraska
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<br />I m t:UNI1fW. thJME .-OOM88 fSl,",ff OR ".F D. NO. cny OR fOWN SIAtE.lltl!
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<br />March 23 1937
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<br />Rosario _.__~~~M~inez______~__..__.
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