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'] F <br />3 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTKENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY <br />OF AN ORIGINAL - RECORD ON FILE WITH THE STATE DEPARTM T OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL D�O51T61tY FOR <br />VITAL RECORDS. 104882 <br />DATE OF ISSUANCE. �a <br />dEP 2 STANLEY S.- MAt. DIRECTOR <br />LINCOLN,_ NEBRASKA BUREAU t)PaKI� "AiISTICS <br />STATE OF [A- OETARTUM M "MTN <br />BUREAU OF vITAL STATtsTlCS <br />COMMATE OF DEATH <br />EDOW -NAME FIRST mfoott L44T stx TDAft 00 otATm rM.: - <br />FA'd23:.M RAM-ND x� BE #- !%le Sertemb�. -:, .1985 <br />RACE •-i.l. SI.�A A...>i>!w flbGplCDESCHIFthw.i..t,­'m_;u 1*of --Aw.. v UteD[E E YEAS ONOEE T DAY '. DATEM:>tTM N.. -D.I. Trr <br />MpS DAIS ' HOURS. mm i <br />to Amery �Tb „ 72 f u` 24 « ;� .: 10, 1912 <br />e AND STATE of R,RYH to ... M USA- £mEEN of w T CCK0ff YS«AriED. <br />+... <....I; �.w1D�DwED_DlYORCEDr t - - - <br />E. Clarks Nebraska MA vR %i3�d w 11, Beulah Hale, dec. <br />UM!LL SEcum" NUMRER -mmooF WyMESS f1►INDU.STRX 2dMlY -d DEATH <br />; 2 508-05 -1691 ;iu Farmer ,'as Grain & Catt1 ;,A. Rall <br />i cAi.rpw"cQtOCATtQNCFDEATH 104sm cfIv1. n' -wwAt coat"""IlrETVTl`ON -4 fl—iM..' �. MOfI Aw1T "41'ss+DDr� <br />i Att hood River #, " i'e mar <br />s ='i:e t'xoor itan -Home i,,, Zupat3 -eat <br />1IMPEHCE. -STATE �CoUNTI jCTFT rov— ORtoCAnON STRE[i AtHI NSt.YE! ros4�s.om�� cm, <br />+MD3 <br />i 3.. Nebraska 1'. Han i - Tk - Cairo 3 Tu 614 S. Alexandria <br />i - .TOT - ..+xDENw MST Mkwmt LAST <br />1+larintis - iits2'ae rT - . - Carrie - - Cerrw <br />wAS.DKlASED EYES IN U. S, f 1p.T NE FrpTSp,- Ma ADDRESS Wvw D t r a <br />aio None <br />E. - RSA ItE !!DC _.- s_b .,. isr n t 6 <br />t,- G..n.e «. R.w...1�DA - ?cV�iTEttT f!R [!lMM1:ORT _ +ywE : tOCATKIN GmDViE <br />a5 'xDs Mt. �be _�.emBtIwY ___"-`----1- <br />Sargent, Ne3�r s%a. <br />E AMEi_L T MC. - �st�WK KIwE -FrAMF M*D A"WSS SWO 6r A. rr .ro. Cm M'. —$TUT <br />Ti -- 2156 a Rhosd Vial Rome, Baas 310, <br />N- <br />t6M <br />�Tt as .. v-1, Y) k LM. Du. rSa OI DEAN" <br />{biz <br />�. ep-t, 4, €i D ice. it <br />DAM '3Dtw D„ -r..;. 1KDLA sEAi« :osoNou -c" MAD " EEONoc. acts aEADrw»; <br />ai i2dA M <br />P. - <br />r <br />�REOaiA�W <br />•ART <br />t ' <br />M <br />L <br />., x7A. rs�...,...e r.N,► <br />- <br />?�Jz3 ii. o d, Grand Island, NE 6a80_g <br />f D/.TE REC RT aw' STAAR r.... D., [r } <br />t 1 L <br />` zse <br />Y T7t.[ CAirSE Ef1f.tMK s C.). Ctrl Cat; - - 1x - sr..3.t- 4wr....w.w- •.w+ - <br />''VwT.wi:Fa a^. YAc a TKI'ST 11Ai.Kt.10 l <br />i. � .AEC.u.�Y,« THE fa:= ]>1M( >Ml .ire•+. [� ...+. . YiAWMl10e [O.O>4e <br />A Y � � �W.31�� 11�•. �i it Lt si...+...... w� <br />AcfddbHl. SUKAC ma mw , 1Io" DI'..NAr sM... o.,. . " '.0'a a .Nnx. « , I'MAAI wow evli#, OC[i - - <br />M ftpwl 6 - <br />- i;i W -00 '4 1'I'M 00 MUYIIT -_Y Ywa'+r. ww.. e.. ;YDrahOM - s fSET D..f n '4 Cm W i0+•! HI�R <br />Tirade 1- -- <br />ji4 <br />I <br />