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86-- 103641
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO B'E A TRUt COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTV @ flF.HEALTN
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY °FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JUN 2 iCl''TFt STANLEY S,: COOPER; DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />STATE OF NEMASM- DEPARTMEMT OF HEALTH
<br />1UREAV OF VITAL STATISTICS
<br />86 04664
<br />CERTIFICATE OF DEATH
<br />NAME if -iT_. ... y.� _ u-3r'- -_ -_?3ii
<br />Ivan Richard M'iddagh r Male
<br />LApril 12, 1986
<br />. QPW —iii. Awl.,itl. qIf XMJOFSCENf I. i -- �"-1i1i•'•!"• AGE _I.w ►•w•� ur+oFa 1 rEAf
<br />(fI.,:FPr fwrr..N.IIS..,:Pr1 �PTn.F MOS DAYS!MWfS;
<br />Ur!DFf r DAr DATE 01 "I'M /Me 0*1* r• 1
<br />WNS
<br />May 16, 1927TA
<br />ite American iw
<br />f MAXMlD.
<br />ECOTTAND
<br />F OF SI XTH (M •N 1. V.S.A.
<br />CITIEfN OF WHAT GOUNfXY MAiiIIN!v
<br />WIDOWED, DIVORCED[SP—Opf
<br />[J
<br />Stroudsburg, Pa.
<br />1, SA. !,D Married
<br />i „Eleanor G. Roberts
<br />UNTTNNMSlR USUAL OCCU ATION (G.w i;M N..r1 e.•x ew.•M ^+�� IfINO0/SUSINESS Of INDUS/XT COUNTY OF OFATM
<br />12085-20-4351 IJ! Broker _ �a a- tub Real. Estate 711 ' -1 Hall
<br />CITE. TOWN OR[OCATMN OF DEATH �CFT'UMITS L`/IOSIITAF OII OTMfRINSTITUTION- N!r fll ner.w..rA.r I— l 1.31 I.�:,.x Do..
<br />�(S ►.rJr Y., .. N.i )S•ti ,MMSwi w.wb.rl �O.x.ri.wrtlr•
<br />,w.Grand Island Ne. -- li,.Yes �,AeGrand islandlMemorial HosP.,„, Emer. Room
<br />ffS10FNC[ -STATF COUNTY —T ;CITY TOWNOf,OCAr10N STXFF7 AND NUMff! IINSIOF CITY I,MIIS
<br />(Sl.r.b_r.r s• NO
<br />I- Nebraska St. Hall s Grand Island ?Ise 24_12 W. Phoenix 1,�• -YYes
<br />. wrnc` -r2 1 -_. � 1.—_._ U�ff— y��N�!
<br />Clifford -- Middagh Myrtle -- Depew
<br />` WAS DECEASED FVER IN U S ARMED POKES? � INFOGUNT -� NAME - I[LA /IQNSNII - MAILING ADOf[SS Intl /l Ot ! T D rD [IM1 W rgw[yr[Hr[ ilf!
<br />:,.., ., wr..Axi IM ,•, ,... ..I . 1
<br />,f Yes �i47II 4%45 -12/47 .Eleanor MiddaBh Wife 2412 W. Phoenix --- -- Grand Island, Ne.
<br />- - - --t - ._ . - -
<br />WRIA[. Cn.y „!w, U-1 A C[MfrEfT Of Cf[MArptT NAM[ .IOC ATION CITY q TOWN ir•TF
<br />April 14, 1986
<br />,a Cremation mb, =,Lincoln Memorial Crematory ”, Lincoln, Nebraska
<br />- - - - - - - 1 - - -- - -- - - -
<br />wTURE t lfC[NSf iY0 �� p(JI J rUN[!wF MOM[N.M[ 1ND wDD![SS <PM /r o! . r o Np OM1 of TOWN varT [.ry
<br />rfkpfel- Butler- Geddes 1123 W. 2nd Grand Island, Ne.68801
<br />IDATE SIGNED (AM D.T- Y. I MOVE OF "ATM
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<br />flfilSTRAR ITOwTi flLFITEO fY lEGISTfAf (M.. 0.,. rA I
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<br />Exhibit "A”
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