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8i- 106898
<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 DEPOSITORY #,OR..,',
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE /
<br />Nov 1 S 99 STANLEY S. 'COOPER, DIRECTOR,
<br />LINCOLN, NEBRASKA BUREAU OF VITAL SIATI$# 8
<br />STATE OF NEBRASKA — DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH L. /I
<br />DE EDEedT -NAME FIRST MIDDLE LAST S K
<br />DATE O EATM (Me_ Do,. Y•.)
<br />Pleyte male
<br />October 30, 1987
<br />Frank C. A. 7
<br />{IesY, Awerisew ORIGIN(DESCENI(e.B., MOlien, llinwo,
<br />UNDER 1 YEAR UNDER 1 DAY DATEOF{IRTM(Me.,DeY.1" )
<br />(SPeErFYI G.—,eWlIfSpecify)
<br />MOS. � oAYS HOURSMINS. �1arCh 25, 1893
<br />e , American
<br />7W=O�Wgll).
<br />ey 7
<br />CI AND TATE OF BIRTH (d nel w U.S.A.. CITIZEN OF WHAT COUD, NEVER MARRIED.
<br />NAME OF SPOUSE (IF.if&, Ei.e weide„
<br />seeeTr? DWOR ED(Sp -,f,)
<br />U.S.A. rried
<br />Lola Grace Reed
<br />{ Gram Island Nebraska 9
<br />11
<br />SOCIAL SECURITY NUMBER
<br />USUAI OCCUPATION (Give kind,, .erY dene d-ing wpa KIND
<br />Of BUSINESS OR INDUSTRY
<br />COUNTY Of DEATH
<br />,7.712 -07 -4373
<br />°''°'L B"`�''°°`f' ° " "d'
<br />„e �"n sneer retired „b
<br />Railroad
<br />Lincoln
<br />Ide
<br />CITY, TOWN OR LOCATION OF DEATH
<br />'
<br />INSIDE CITY LIMITS
<br />(SP -01), Ye. o• N.)
<br />MO OR OTHER INSTITUTION -Neese fll nor �. «rA «, Ir HOST WrHSt IwdI.e ..w.
<br />pin Hnel d n.w •1 OwMtyyn /t r Re. Iweeu.« (Sp«d,)
<br />,.`North Platte
<br />Ids. no
<br />idd. fit. Box 217 IN lV [{
<br />RESIDENCE -STATE COUNTY 'N,TOWN ORLOCATION STR III AND NUMBER INSIDE CITY IIMITS
<br />I7b.Lincoln Ilk. North Platte „d Rt 3 Box 217 ;3in'Y " °' " °'
<br />1>a.Nebraska _
<br />A N -NAM I! FIRST MIDDLE U MOTMN- MAI-IN NAME FIRST MIDDLE LA
<br />Cornelius Abram Pleyte Rose Caroline Hansen
<br />,.
<br />WAS DECEASED EVER IN U.S. ARMED FORCES? INFORMANT - NAME - RELATIONSHIP - MAILING ADDRESS IsTut, OFT t E O HO. CIT66AW 51A1E. 1111
<br />w. sweH• er w...r.l
<br />IT. wa, «.wt1l q d d
<br />•. IIl ,e•.
<br />PLeyte,wife,Rt 3 Box 217, North Platte, Nebraska
<br />I.. no ,9 Lola
<br />BURIAL,Crew°6 114 ° 1 AT CEMETERT OR CREMATORY - NAME LOCATION CITY IM TOWN STATE
<br />NorIth Plate �etery North Platte, Nebraska
<br />2, 1987 i 70d
<br />70M.Ab riaEl
<br />AroRE E U7c�ENSNov. T I
<br />`u ADDRESS 1{r,EE, Ho
<br />2561 69103 -0489
<br />�� ,Adams & Swanson, 421 W.4th,North Platte, Ne.
<br />:r�
<br />DATE A/H (A»., De Y, wJ DATE SIGNED (Me De,, Y..) iMOUR OF DEATH
<br />_
<br />A ^,: i
<br />e -
<br />::r0 7so 716 M
<br />DA ND Me.. D Tr. "OUR Of DEATH _.i PRONOUNCED DEAD PRONOUNCED OEAD(Ne..)
<br />�I(Me. Do,. Yr.)
<br />7 / 7k. . �Q _ M . M
<br />,, �2k
<br />i ie rw rM . M • eN d.e H rM 213 h Yer• N . i1w ere- N/« der. ewd I1-. sN d.. H Me <e.rHN
<br />_ fstw«.„ eN Td.) w
<br />S OF HIES (PAT IAN, CORONER'S PHYSICIAN OR COUNTY ATTORNEYI (T,PI o• 11 -1)
<br />Dr. Cleve Hartman, M.D. 810 West Reid North Platte Nebraska 69101
<br />1. REGISTRAR DATE RECEIVED BY REGISTRAR (Me . De,. Tr -)
<br />NOV 91887
<br />7w. f sHeN «N► 7eb.
<br />7 IMMEDIA If R OHL E AUSE PER NE f ol. P6J, AND (d IwH�..n..- . «s....« .w•« •wd d «M
<br />PAINT
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<br />r deeM W. MT WAS IMtw NltttEO !O MlpCwE
<br />T MlR n« •N.M P N M FfMALE.
<br />MlGRANCT IN TMtIMi7MOH/N3? Is_,,, r« «w) SIAMIIN'ION COSOHIA
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