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87-- 104146
<br />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 LEQAL'DEPOSITORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JUL 10 1W STANLEY S. COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF V1TALSTATISTICS
<br />He-z- ASIA
<br />STATE W NOWAM- OPAW&MV of NMTH
<br />VMW W 1RTAt sTATiam
<br />CERTIFICATE OF DEATH,- 8 1 4 6 4 5
<br />- mime LAST
<br />IT
<br />CATE OF MAIN (MP., D.,, Tr.l
<br />Lee Alice Pendelton Camper
<br />Female
<br />April 1, 1981 3.
<br />-N.E.. WAi1., N.[L, wr..sA. OMWN/DlMtM (. R., M.l:...AWMM• AO!- A...:...[.T
<br />I.i:.w. sar Ip D«......Lus.«a,,
<br />UNMR 1 TEAR NMR I OAT DATEOF NRTHIM.- D.T,Tr.) —
<br />AIOS. OATS NOUB • Au "s.
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<br />S naascfc American R, 56
<br />September 16 1924
<br />w ' P R
<br />ED.
<br />COTT AND STATE OF *WIN IN .« i. U.S.A.. ICITIZEFf OF WHAT COUNIR [AAgI�o
<br />NAME OF SPOUSE (N.ih, vi- .NIP.
<br />oIv �R cE
<br />�.ouisa, Virginia ' 4 �, U.S.A. 0°OflairieGorsP « b)
<br />„Roland Camper
<br />SOGAL WCUSM NUAM M USUAL OCCUPATION (G:.. i..i.1M A.w. d— f..... WINO OF RUSTNESS OR INOySTII COUNTY OF MAT"
<br />.I wrR Mw.( ./l
<br />,Z. 506 -18 -5470 ,� useWe „` Domestic Hall
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<br />CITY. TOWN OR LOCATION OP MAT" 04W CITY LMMTS HOSPITAL q OTHER INSTITUTION - N.— ( ".N i. .:IA.r, W "" IN'll, I..M... DOA,
<br />r r « «NPJ v...�T.�.I .w.) ov.li.rJE... r.M�..«.ISP...r,l
<br />, Grand Island 14 es ,y Lut elan Memorial Hospital ,M Inpatient
<br />NSWNCE -STATE
<br />COUNTY I CITY. TOWN OR LOCATION I STREET AND NUA S12
<br />INSIDE CITY LMUTS
<br />,S,_Nebraska
<br />�,�_ Hall ,xCrand Island ,� 721 E. 8th
<br />�S7e.T,s « «N.,
<br />- �- MIDDLE
<br />mAMIN MAW NIIST LAST—
<br />William A. Johnson
<br />Marie C. Farrar
<br />n.. r+..r
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<br />,,Roland Camper Husband 721 E.
<br />....a.. a�.........V.. c... V. K A.R 3N1 ROI
<br />8th Grand Island, �e.
<br />SUMAL. C.R..Iw.,
<br />3, 1981
<br />CEMETERY CO CREMATORY - NAM!
<br />Grand Island
<br />LOCATION CITY OR TOWN STATE
<br />Ta.Burial
<br />nbP
<br />Cemetery
<br />Grand Island, Nebraska
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<br />;1'UNEW NOW -NAME AM ADDRESS ISTREIT 08
<br />E T D HO.. CITY OR TOWN. STATE. ZNI 68801
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<br />1,,Apfel- Butler - Ceddes 1123 W.
<br />2nd Grand Island, Ne.
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<br />�I Wit 1 1981
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<br />C.D. McGrath 729 North Custer Grand Island, Nebraska 68801
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