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1
<br />IN
<br />87- 106706
<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 DEPARTXE&T'DF,•HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL ;6: Os"ITQRY`FO1t,
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />3
<br />NOV 13 1W
<br />STANLEY;$•,COOPER, Ri EGTOR
<br />LINCOLN, NEBRASKA
<br />BUREAU OF VIiEL "`,T�TYSTICS
<br />STATE OF NEBRASIIA— DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH ;
<br />DECEDENT-NAME FIRST WDOILE LAST
<br />3
<br />DA E OF O ATN (M... Door. Yr.)
<br />Leona Miller
<br />,Female
<br />,November 8,1987
<br />RACE -M.9- �•• N.ek A...:..n OR1GiNJDlSCENT(. 9..Irol:on, w.:.aw. AGE -Ir R.ny.,
<br />UNDE! 1 YEAR UNDER, DAY DATE OE NOTH(M.., D.1, Yr.)
<br />IrM:e•, •kj(SI•<ifr) G.TNSw, •V[.ifSp «i/rl (ynI
<br />Aite ,American ,p 79
<br />rroS. GAYS HOURS• MINS.
<br />R►. a ?.April 22,1908
<br />CITT AND ATE Of MATH (M —:,. U S.A, CIIIIII OE WHAT COUNTRY MARt1ED, NE E! MARRED,
<br />NAME Of SPOUSE (N.:h,
<br />.sr < .oNr) Wlppw[D. DIVORCED /Spaci /rl
<br />.. Wood River Nebraska , U.S.A. ID Married
<br />„ Howard Miller
<br />SOCIAL SECURITY NUMRER USUAL OCCU I.I. —(G:.• kind.1_'k do n. d.nwq~ RINDOFRUSINESSORINDUSTRY
<br />COUNTYOf DEATH
<br />n:l nrJnd)
<br />I
<br />12_508-46 2 13.. F,.; er 13b
<br />lb am
<br />CITY, TOWN OR LOCATION OF DEATH
<br />INSID1 CITY UMIiS
<br />HOSPITAL OR OTHER INSTITUTION -NOM ftfn•l:n nlF.r, 11 NOv Of 1.'$I Mdk.r. bOA.
<br />Kenesaw
<br />(Sp.r:l,•Y...r N./
<br />,•n .In .o dn..s,� Wr1.r:.wr /Yrr h.rw,.rv.wr lSV..A,)
<br />ien
<br />1db.
<br />,.<. s
<br />led. t1(�e ,.,Inpatient
<br />RESIDENCE-STATE COUNTY
<br />CITY, TOWN OR LOCATION
<br />STREETANONUMRER
<br />IN SIDE CITY LIMITS
<br />SAebraska I3s.Hall
<br />IN
<br />it 1 Box 62
<br />«1f,
<br />FATHER -N MIDDLE LAST
<br />NAM 1145T MI L1
<br />&ward Brittin 17
<br />MWme Boyle
<br />WAS DECEASED EYFR IN U.S. ARMED FORCES?
<br />INFORMANT - NAME - RELATIONSHIP- MAILING ADDRESS ISTRET ON a F D NO, CITY ON TOwN Swi. 5111
<br />lT.,, w. r .NI IM Tw. ,iw wr w aaw N r.w..l
<br />62,Kenesaw,NE.689%
<br />TR. No
<br />,,.Howard Miller,Hasband,Rt.1,BC
<br />WRIAL, C—ficn, 1-110AII
<br />CEMETERY OR CREMATORY -NAME
<br />LOCATION CITY OR TOWN STATE
<br />'"d
<br />2o.H11rial 2%No►.11 1987
<br />2N. Kenesaw City Cenete
<br />Kenesaw NE.
<br />9MISAUSIR-SIGNATURF A UCENSE NO. 4073 0
<br />124ackson-Wilson
<br />FUNERAL HOME -NAME AND ADDRESS ISTRIT on RF 0 NO. Crrt ON TOWN, STATE, 5111
<br />2,. v'" WI.-I
<br />Funeral Home, BL G. Kenesaw, NE.68956
<br />O R OF D! TNT" (� AM., 0. V. V.
<br />A SIGNED (M.. 1M /. Y•.1 HOUR DEATH
<br />117
<br />^Sr
<br />I2db.
<br />yE
<br />27..
<br />Jig
<br />7d. M
<br />i
<br />�C{ (Me..DpY,r..J
<br />Y,.1 NOUt Of DEATH
<br />PRONOUNCED DEAD PRONOUNCED DEADIH..r)
<br />6lt
<br />2�. 2k. M
<br />}z
<br />2
<br />.(SR•.bv.wr:a.)► MTC
<br />R Y IAN. COtONEr3 NY51[IAN M CDUNry
<br />InMN..1
<br />2w.ss;.,...�..e r..N�
<br />rT...� ,.. I...rr
<br />Da Grin
<br />niel R. (conk, M.D.. 908 N Howard At, d Island, NE. 68801
<br />REG1 TW
<br />JDATI RECEIVED BY REGISTRAR (M... Door. Y..)
<br />»..( ► 26b NOV 1 3 1087
<br />M IN" A (ENTER ONLY E CAUSE ►ER LINE FOR f•1. (6), AND (<1) IwnN b.rw.. ..,N .y d...
<br />►�
<br />N
<br />out 10. 05 AS A C ENC FOP: Nr.r.•1 b— .aN w d..rb
<br />Lbl
<br />out TO. 01 AS A CONISMUENCE OF: 1...,..1 b— .mw w d...
<br />' I)t I :°e:-'_a ^d, ".• Ei ^f t }.P 4£j ome t -,e SST ^f e N of Se t 24; *:
<br />,� a b} C Ben ti•e 7; the tr a SM; F, to f
<br />3•c':�n Lo:e -d 1, !,elal.rC ^f Sect.�n 25; 4LOt 1 :'EE1nlFkr.B ^f 9eot ?on 2 ?; the S1 �• t: a !r'
<br />of Sect:o,r. ±j, nl' ... Tovn®`1p 4 .rth. ?'In_e 1 'Beet -f t:-.e 5t:: P.'!., Hall County, NebrFig1m.
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