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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL. DEPOSITORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSL'ANC ®GS3
<br />AUG 0 ic9b 5 STANLEY S. COOPER, DIREGTO
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />LIE DI:RS IEIMO: ry ;; I' � •' U f ,
<br />STATE OF NENGSKA"f� (W HEALTH g 5 07263
<br />BUREAU Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />DECEDENT -NAME f1 /5 MlppLE US ^'3!M jDtE Of AEN (Me.
<br />Norman Walter Edic , Male ;, June 3, 1985
<br />RACE - le.B., NrM1:M, q«1. AANrifen ORIGIN /DESCEN((e f., Irof- n. We ^, AGE -I.w I:nbde, UNDER I YEAR UNDER I DAY I PATE Of BIRTH (Me , Dv,, rr /
<br />lnd+sn, N[J (Sp «i(,j +Cmewn, Nt 1(SD «dY/ (Y" I MOS. DAYS HOURS MI 1
<br />A White !S. American 0 l,,. 60 I,b 1� tae tember ii IF 1924
<br />CITY AND STATE Of BIRTH IN •wt •n U S ♦ . CITIZEN Of *MAT COUNTEYIMAE11E0, NEVfR MARRIED, 1 NAME CN SPOUSE (N .Ih,
<br />BN".—Y) !WIDOWED, DIVOKED (SV)N:fF) i
<br />ewman Grove Nebras U.S.A. ,lever Married
<br />SOCIAL SECURITY NUMBER USVAI OCCUPATION (Gi +, i:•.d o1 w.f do•.e de.�nB w«r I KIND OF ►USINESS OR INDUSTRY COUNtY Of DEATH
<br />°(' °'''^ ''`'.•- nNreb,.d, Sel - o ed Cars
<br />8 -2 -12 I]e Mechanic Sos .°Hamilton
<br />CITY. TOWN OR LOCATION Of DEATH INSIT OF CITY LIMITS NOS/ITAI O1 OTIE[R INSTITUTION - N°n° (I( not- eohM tf NOY O° .$I 1.d:.— W.
<br />1(s, «d Ye, orNol Ip:.. Nond b.rl Or+,srwne /l.w. M.Neen,w.lS,wdri
<br />_ ,., Mar uette ,4 too ,dd dim home Rural Route# ,.e DOA
<br />RES,DENCE -STATE COUNTY CITY. TOWN OR LOCATION STREETANONUMBEK INSIDE CITY LIMITS
<br />(Sp.s r.. -Ne)
<br />,S.Nebraska ,S► Hamilton 'I><. Mar uette ISd. Rural Route 1 ,, �o _
<br />♦ N -N 1
<br />M.—t US M [HER- MAIOEN NAME FIRST MIDOL LAST
<br />16 Walter Edic ,, Bernice Petersen
<br />WAS DECEASED EYER IN US. ARMED FORCES? 48
<br />INFORMANT- NAME - RELATIONSHIP- MAILING ADDRESS
<br />.w• fn Ye• ,fTlf ll OR ° r D NO. CtM1 O/ tpww. Si•r!. ]tI)
<br />ye w• s d Jew. 1 N•••.e)
<br />IBYes W II 10 24 44 -1i 1 4gichard Edic.Br_other°RR2,Central City,NE 68826
<br />BURIAL, C ,wolwn, letwewi OA E CEMETERY Olt CREMATORY - NAME LOCATION CITY OR TOWN STATE
<br />2D.- urial tab. Ju 7 198 20,.Central City Cemetery j?w Central City, NE
<br />i�;/I�GNAlyRE LICENSE /� "l 3' _ UNEIIAl HOME -NAME AND ADDRESS ;STMfT W 1 f D NO. C'" OR TOWN, STATE. Zt.) 68826
<br />71. -.�' ( [•�_� !SRolt Funeral Home Inc 150? 17th Central City,N_E
<br />DATE OF DEATH (Me_ De,, Yr.) � DATE SIGN O (Mo. Do,, Ye.) HOUR Of DEATH
<br />s ID
<br />»,. June 3, 1985 .1 �24e _ j,•b. M
<br />9i-
<br />DATE SIGNED(Me., OPT, Yr.) NO EA 1'i /RONOUNCEDDEAD �►RONOUNCEDDEAD(Heer)
<br />June
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<br />M \
<br />v +x 2
<br />24 M. M
<br />23d (S
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<br />»:w:ew heM N<r•wJ eM r
<br />2" .f•,we.rw ewd t•J,I ►
<br />NAME AND AODRESS OF CERTIf1ER I NYSI H, R' PNYSKIAN OE COVMT ATTORNEY! (T,p1 er Lint)
<br />�2a E. T. Zikmund, M.D. 2%'_ _10 18th Ave. Central City, NE 68826
<br />r RtGIM" L,(V1 ; DATE AFCC{EMSVE�D f�Y REGISTRAR (Me.. Do,, r..;
<br />�2Ae.rsw..rrt.,► ���� /v ��i.Q,•bi ___ '2Ab. A - � / �Qgs
<br />77. IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR (e).
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<br />t DU f0. O1 AS A CONSEOUENCE OF: i w.ret b--
<br />DUE TO, 011 AS A CONSEOUENCF OF � n i e.r..« .....t ewe d »M
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<br />3" _ Xlb. 34
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