|
I-
<br />87001R- 104286
<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 DEPAOMINT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITARY "FAR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE A +
<br />JUL 16 Wj STANLEAt �o 'D;IREC TOR
<br />LINCOLN, NEBRASKA BUREAU OF VAT VATISTICS
<br />STATE OF NEBRASKA-DBPAKtMEIVT OF HEALTH
<br />sur"m of VIM SaUNkR
<br />CERTIFICATE OF DEATH. /. -� :,, 7 K i d 1 4 k
<br />YIM1f l• I X
<br />DATE Of DEA 1 YONIN, RAY, I\AI 1
<br />r1Nr
<br />r DEArA WAS CAUSED IT I(NIER ONLY ONE CAUSE PER INE " (N). (b). AND aq
<br />1 M I
<br />S
<br />TAU w111{, NKO. A•YM•Y
<br />I 1 NI
<br />I
<br />001 d WM
<br />CO UNY d NO"
<br />6w NII
<br />OMI
<br />K I
<br />M
<br />\YNNI CAYN fN1
<br />I
<br />.
<br />1.
<br />{
<br />I/
<br />04 CP ♦
<br />AUIO►SY
<br />w0.
<br />O&W W b/ .w I.MN, cM II41, A.6 NY•WI I
<br />•
<br />sncN. wf o• Yo
<br />N1/6NANCY w /1N EAST I MONTN{t
<br />. /If
<br />yes
<br />---
<br />"'B11-
<br />STAI! d EIEEM 1 N YET .. III. . Yw
<br />Of WHAT COUNTRY . N[vq MARRMD, RYO s/•nusE . N �Nf, OM .•.tw •Y.Y l
<br />CRYNIw 1
<br />WIDOIA'EO, DWORCED
<br />E
<br />{ II6A 1{
<br />USUAL OCCWAMON Taw I" M r6N .ONt pyRl.Nt YoN w RNID OF SUSINISS OR INDUSTRY
<br />SOCIAE WUNY MOWN
<br />r� L
<br />17 2- 6-
<br />.O.N. 1N/. M!w Ir .w . 1
<br />11 m - �i� In —
<br />EESID!{CE -SI ♦ft
<br />m, TCYAW. OR IMAM"
<br />COVI CIM
<br />c
<br />I fI1 M w
<br />$10111 AI=
<br />Ij
<br />N.wAf "cum EYES RIE U.S. am" ww- ISf
<br />"**,C, ADDRESS
<br />M/, q�j «rAN.w/ TAI r•1.N+w N.Y Arw w. CN. CA *W3, Irl
<br />nr1.w,E T.7.YId -N. -1
<br />to 205 lairwirficond St. E eland 11E 68 Ol
<br />Mestlawn Awwria) Park brand Island NE _
<br />,AIIMw, 6•Y, /IA/ I Wt1E4 AC NOME —NAME AND AOMSf . ffN1i a I.r A. w6., Cm M TO.N. fury, CN .
<br />ML DeOY 16 197 LiWim t
<br />e■1IURw- 900MAYUN L UCIPW NO - 11Mf 11 LOCAF NO nr
<br />INDEX AS TO:
<br />Lot One (1), in Block Six (6), in Kay -Dee Subdivision,
<br />located on part of the Southwest Quarter of the
<br />Southwest Quarter (SW 1/4 SW 1/4) of Section Twenty -one
<br />(21), in Township Eleven (11) North, Range Nine (9)
<br />West of the Sixth P.M., Hal -l. County, Nebraska, as
<br />surveyed, platted and recorded.
<br />Is
<br />m
<br />r DEArA WAS CAUSED IT I(NIER ONLY ONE CAUSE PER INE " (N). (b). AND aq
<br />Nfr/M ""I A" NAtw
<br />N
<br />' A
<br />NI
<br />�^
<br />C6MMCN1 /. N Arr,
<br />.INCH RAN NN ro PI
<br />NAY/N•N CAYN N, NM q. OR N • CONYONNtr W
<br />/IANM Iw! YNOK
<br />�
<br />\YNNI CAYN fN1
<br />ICI
<br />PAW R. dtINR R1611111CArlt CO,IRItI IF CO,IMIN)M{ C6N /.RVIMr61O pEA/N Wr NOT fYtAll6
<br />PAN INYIE. WAS /MINA
<br />AUIO►SY
<br />w0.
<br />M YES rl!/ 1I wNNOi CO,r-
<br />MNlN I« N,IMIw,wO CAYN
<br />tO C� � N PAw Vol
<br />N1/6NANCY w /1N EAST I MONTN{t
<br />. /If
<br />OI NAIN
<br />RS O NO
<br />IM
<br />IRI
<br />SUACM. iiame
<br />VT or 1YOwrw. r.. .u•,
<br />NOW INJURY OCCUR 10 • -,- N.ruw w 1Nw.. 1N r•n
<br />.
<br />DA IINDfEEYYID IMCN.1
<br />EA M.
<br />!RI
<br />NMIRY AE WaR
<br />PLACE OF DQUEY AI •OY/, I_. MINI, IAC/ORI,
<br />LOCATION ..Mtl W I.I.R. w0., CIn M IOrw, N•M I
<br />1~ A{ M MI
<br />ONK/ {IRE ,!K I\IlCIII I
<br />rN
<br />�
<br />YaYr
<br />•1u
<br />..1N uN yr r /INI A1,w OY
<br />1 w /AYAYM•ANr nN
<br />pEATN O0111- :CURSED •r MI NKI, oN ,11I
<br />ICA110N— Y6wtw N• nu
<br />NnNE1Ml1 � IO t
<br />/
<br />11w1M nM
<br />IWI •TIN N•M
<br />L
<br />.Npyl. RAn, AM, q M MM
<br />� w Y/ IwOMtlIN, w1
<br />lh R /pAY6 ,lOY
<br />OY ON MN M M
<br />NOW OI N•M
<br />1N � 1 yAf rYOM6YwC \{ NAD .e•r •OY•
<br />{YMIAtIR1161p M MINER M NW {MMNDN. N1 n WYIt6Y,
<br />RN1r 00[Y/ll{ a M MU AwN NR q M [AYINN MAM
<br />M
<br />...
<br />� M
<br />u. A t1y RAI, IWI
<br />to 205 lairwirficond St. E eland 11E 68 Ol
<br />Mestlawn Awwria) Park brand Island NE _
<br />,AIIMw, 6•Y, /IA/ I Wt1E4 AC NOME —NAME AND AOMSf . ffN1i a I.r A. w6., Cm M TO.N. fury, CN .
<br />ML DeOY 16 197 LiWim t
<br />e■1IURw- 900MAYUN L UCIPW NO - 11Mf 11 LOCAF NO nr
<br />INDEX AS TO:
<br />Lot One (1), in Block Six (6), in Kay -Dee Subdivision,
<br />located on part of the Southwest Quarter of the
<br />Southwest Quarter (SW 1/4 SW 1/4) of Section Twenty -one
<br />(21), in Township Eleven (11) North, Range Nine (9)
<br />West of the Sixth P.M., Hal -l. County, Nebraska, as
<br />surveyed, platted and recorded.
<br />Is
<br />m
<br />
|