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<br />8711... 106074
<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 LEGAL, AEPQ$ITORY:F1lR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE �
<br />OCT 14 687 STANLEY S.. COOPBR ',ptECTOR,
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />jy �G. Iy'a -� Iaf 1C J F 0 Block .73 l)i.;fer ° >'L 7 h�(c.e L
<br />STATE OF NENnM- DE►ARTMENT OF MEAITN 82 05870
<br />WREAO OF VITAL STATISTICS
<br />CFRTIFICATE OF DEATH.,
<br />MOUNT -HAW YI M LA A A IAN., r, Y/.1
<br />Carroll Clifford Nixon Male Hay 61 1982
<br />RAC- 1•.R.. ►.A.«IS.. ORIONUDISCENT L•.R.. YI.1,•n. Mr.k•n. •OE -L.Y RIwW, N RIY AR 11 AY DATE Owe L11/NfAN., DRT, T,.1
<br />In�N..MJ(SRwAI) ORnRRK• ESTd(ERwIly) (ml MOs. DArE NOURS • MIN$. Nov. 14, 19L9
<br />,. White AERerican r (. 62 w
<br />__CjW_A_ND STATE OF ONM (1 KN i. U.S.A., ITI N OF WHAT COUNTRY MA F N R ANRRIFD, N,NIF 0/ fIOUSt ( . R^•..TIh. ^ �
<br />••r .«IINry) WIDOWED, DIVORCED f $pwily)
<br />Burwell Nebraska , U.S.A. ,D. Married ,, Etta O'Brien
<br />SOCIAL SECURITY NUMRLR USUAL OCCU►ATION(Om bilM •!.•/i luN briny .Iwr K/ND 0/ SjE/e $TRY [OUNIY Of D[AFN
<br />•I a•/bi 'ti Rwn HnN1•�1 ffi 1
<br />u 520-16 -2265 ��..alea '' I�b.Whq-,, sa es ,,, Hall
<br />CITY, TOWN OR LOCATION Of DEATH INSIDECI -L-ITS NOS PITALOROYMERINSTITUTIoN -N— rllnNi.•i#A./, 10 NMOS/ OR/�NST` r DOA'I «MI
<br />fSpw Tw w N•1 Rir• MNy n1 n•nlbw)
<br />Grand Island , «es 1« �utneran Memorial Hospital ,,.Inpatient
<br />14111 RLSIDlNCE —STATE COUNTY CITY, TOWN OR LOCATION $113111 AND NUMRER INSIDE CITY LIMITS
<br />lso wUy r ier No)
<br />,3.. Nebraska I,b. Hall IS. Grand Island 13d 1911 N. Sherman I
<br />• - AY U MO NFR -MAI NNAM FI MI '(
<br />Harley Nixon Maude -- Sherman
<br />1 OR A 1 0 NO. CITY OA"JILATp19. ZIP)
<br />fY« w, r w�N)1I��M .«. •�- ..r - .. .1
<br />IR.Yea /� II 1 -24 -. -42 -2 12 1.2--8 -44
<br />IT. Etta Nixon -Wife -1911 N. Sherman -Grand Islan .
<br />BURIAL, C—.Oi n M•I '
<br />CFMETEXT OR CREMATORY —NAME LOCATION CITY OR TOWN STATE
<br />Burial 8, 1982
<br />,N Westlavn Memorial Park sw Grand Island, Nebraska
<br />7a. 200y
<br />— AfWE S LICE SL NO. ] 3fa
<br />fUNERAI NOME —NAME AND ADDRESS IS+n[r OR cr D ND. un oR +owN. Surf. 71x)68801
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<br />„Apfel- Butler - Geddes 1123 W. 2nd, Grand Island, NE.
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<br />R'S ►NYS IAN OR COUNTY AT10RNfY1 (lyp• •/ I/inl)
<br />David Colan M.D. 729 N. Custer, Grand island, NE. 68801
<br />DALE LECfIVEAD LY REGISTRAR (M•., Day, Y/.)
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