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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 FOR-""
<br />VITAL RECORDS. Qc n
<br />DATE OF ISSUANCE 8fi-- 1L4869
<br />i u , 2 , t9sel STANLEY S. , COOPER,• DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATTRT7r.-q
<br />STATE OF XEMAW- WAffW0R OF HEALTH
<br />AUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH L
<br />DECEOEN -NAME
<br />#lost 41 U EE IDEA E Of RAT.w.. D•I. rrl "'._
<br />1. Hazel Blanche Busler j7 FeIDalej� July 2, 1986
<br />RACE -1. -f • WMiN. BI«k, AANN:,.w OMGIN(DESCENT1. f..IN:sw.A4.N.w, AGE -- B --" UNDER I YEAR UNDfR C OAT OATF 5i- T'i-i- .r, r. ) --
<br />rwdi•w..a.)fsMNNifr1 GENw.w, .,. 1 ISTI-00 1. tr...) MOS. DAYS; HOURS. DAY
<br />�-
<br />A White s. American ., 67 w ., �7Nov. 1, 1918
<br />_
<br />CI AND TATE OF fIfTM (d w .w U.S. a . CITI2 EM OF WHAT COUNTRY MARMEO, NEVER HARMED. i NAME OF SPOUSE (if -,I.-
<br />E__V) WIDOWED, DIVORCED (STI -Fri
<br />B Madison Nebraska i, U.S.A. lo. Married i „Earle S. Busler
<br />SOCIAL SECURITY NUMBER USUAL OCCUPATION (G... k..d.f.•rk d.w. d..,,., w.Er .INOOF BUSINESS OR INDUSTRY COUNTY q DEATH A
<br />.!.!,king IA.. ...w :h•nr.dl
<br />17 508 -03 -0939 ,n. Housewife i,76. Domestic Iy Hall
<br />CITY, TOWN OR LOCATION OF DEATH INSIDE CITY LIMITS HOSPITAL 04 OTHER INSTITUTION-N...• (If w•,.w ..Mw, H,.DSr D.-1, ..•.<w. Dow, --
<br />(SP «.lr r«.. N.l gi «,rr.N.wd.wwMr/ �0...w�...tkww ■.. ..wwr.ISwwr,I
<br />w Grand Island L.. Yes 1,s.St. Francis Medical Center ,.. Inpatient
<br />RESIDENCE -STATE COUNTY CITY. TOWN OR LOCATION 5TREETAND NUMBER ! INSIDE CITY LIMITS
<br />fS Vnw N.I
<br />Is. Nebraska u�. Hall Ix Grand Island ',>d 411 W. 16th Yes
<br />IS.
<br />A -M MIDOL UST MOTHER - MAIDEN NAME IR MI E —`—
<br />14. Percy H. Ginn i17 Ethel - -- Remington
<br />WAS DKEASED EVER IN U.S. ARMED POKES? I INFORMANT - NAME - RflAT10NSM1P- MAILING ADDRESS IAN(r W., D NO. UP W +OWN s +.T1. ln;
<br />' ..SIIII E ER =SiTMM•NF A. F
<br />6688p T
<br />u No ,vEarle S. Busler- Husband -411 W. 16th -Grand Island�AE
<br />BURIAL. DAT _
<br />C,.w.T:<w.. R.we.el CEMETERY OR CREMATORY -NAME ( LOCATION CITY OR TOWN STATE
<br />July 5 1986
<br />'
<br />Burial xB. wr Grand Island Cemetery !md Grand Islands Nebraska
<br />!- SIGNAFun B UCEN NO. E/� ` ! FUNERAL HOME - NAME AND ADDRESS (WINE, OR., D ra n cm o. ,o....iTA1-9 tw.
<br />V
<br />InApfel- Butler- Geddes 1123 W. 2nd, Grand Island, \E. 68801
<br />' .1 IR I, ,EAULE WAS THEN A AUTOPSY --
<br />OR._
<br />DATE SIGNED (M.. Dsr. rr.) HOUR Of DEATM
<br />NI INAMCY IN TH! PAST S YDNTNSI fS«<.,, Tw w w
<br />: }
<br />2 July 1986
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<br />IpNOUNCEDDEAO ;►RONOUNCEO DEAD[Ne.r!
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<br />3 Jul 1986 4 :motif
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<br />AND ADORE C IE SICIAN, CORONEWVPHYSKIAN OR COUNTY ATTORNETI (TrP. w h.nl)
<br />S. F. Nabity M.D. 2444 Faidley, Grand Island, NE. 68801
<br />REGISTRAR
<br />DATE RECEIVED BY (M._ WT. Y, )
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