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WHEN THIS COPY CARRIES THE RAISED SEAT. OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BR A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE A .H Til
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL D I_ it
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JUL �� STA f W, . 'TOR
<br />LINCOLN, NEBRASKA B,UQR$aAU•((•�0' 1iEiJ '' S A'�TRTICS/f/�
<br />/
<br />STATE OF NEMASM -9 PAW"017 OF N MTN
<br />IUMM OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />mime LAST t A IAN -. p,, rr )
<br />Claude Louis Olson Male i,June 21, 1986
<br />N�IN.1f . k AwwNM fNT N.f.. I ONW, MINN-, ^,•r f4wAP►, R I A t 1 DAT DATE OP NfTN (M•., D.,. Yf.)
<br />$MR" lf11 -ih1 W.w.,.•k)(SP -Ihl Cb (rn.)
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<br />Ritlite American 62 .,. , -May 13, 1924
<br />STATE CITE AM f w... lI ZA., 1 N WTIAT N NA" of SPOUS1 IN We* #," -i •.. f
<br />WTDOWEO. pIYORCEDlSP•.%f,)
<br />un efr, Nebraska . U.S.A. ,D, Married ,, Ards Cool
<br />loci" "Culff" MURDER!
<br />Y3LIAI OCCU► •LION (Gn.liM.l..111tw. MiwR wI.N RINOp RUNNlSS ORTNOUftRT COUNIYWDEATN
<br />12 JVO- JV -JJl1 , bales
<br />I.OUnY/e101
<br />ISb. {JCVaa tulcu� o,.v 1. •• - --
<br />Cf11'. OWN OR tOCA1"M OI DEATH
<br />INSIDE Cm IYMES
<br />HOSPITAL Ot OTHER INSTITYIION- N«wr !If w•I iw wiMw, M— I. mv"w (50" ri
<br />rs rw «N•1
<br />a^•
<br />Memorial Hosp. Emer. Room
<br />Grand Island
<br />,k�es
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<br />MSiDENCE -STATE
<br />COUNT?
<br />CITE, TOWN OE LOCATION
<br />STRE[T ANO NUANE!
<br />INSIDE CITY LOANS
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<br />,SR. Hall
<br />11, Grand Island
<br />ISd 1515 Church Rd.
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<br />FAIM-MAMA FIRST AVOW U
<br />- MAI01N NAME FIRST
<br />Hugo - -- Olson
<br />117 Alice - - -- Lockard
<br />Wµ DECE.KED fYlR N/ Y.S. AMND ►OKEST
<br />,NPOWWNI - NAME - RILATIONSNIP - AWNING ADDRESS 111141102 E 10 ND, CITY W TOWN. STAIR. SN)
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<br />,.Arda Olson- Wife -1515 Church Rd. -Grand Island, NE.66801
<br />CEME111Y OR CREMATORY - NAA! - LOCATION CITY On Tow ✓. STATE
<br />RUMM, C1.ft0i -.
<br />Burial
<br />Tune 24, 1986 x11.
<br />rDI Grand Island Cemetery la. Grand Island, NE.
<br />TUNfRAI HOW -NAME AND ADDRESS I$T14f1 OR E f 0 NO. C." on TOWN. STATE. 1w)
<br />IIEApfel-
<br />Butler - Geddes 1123W. 2nd, Grand Island, NE. 68811
<br />OR•IN /RIR., . r..l
<br />IMIT 510-10 fM•. P. ..1
<br />DEATH
<br />June 21, 1986
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<br />B. D. Urbauer M.D. 2444 Faidley, Grand Island, NE. 68801
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