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I
<br />RE- RECORDED
<br />W.- 105736
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTHEHT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTNENt,1OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSxTORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE '
<br />OCT 110 STANLEY S c ' COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF V1 kA STATISTICS
<br />STATE OF IIEIMM -111 TARTMENT OF MMIN li lT711
<br />iiiKW OF WWAL STATISTICS
<br />CERTIFICATE OF DEATH rJ
<br />I WDOLE WE Im JDATT OF 51150 (�, pA, ►r.J
<br />vn .f- T]nsn rlio LMnlu I_ d.. n..cr 9a loaf,
<br />-4w 7.. Ebrb. A.•.k•+
<br />O/OMj♦tSCtNTh { . M•x «. Ar.:ww.
<br />AGE -,... u..v.,
<br />NOtf 1 TEwtr UNDEE 1 OAT
<br />DATE OF METH (r•.. D•,, V, J
<br />I.d;_..wj1Sw•rJ0
<br />O.T.!•.. a,1(f.«.E,I
<br />fTn.l
<br />ATOt. DAri NOWS- rITK
<br />•. White
<br />American 0�
<br />75
<br />k
<br />,, June 23, 1911
<br />2 • a MErN r ..• . U.S.A. cm:w .NAT c AL1
<br />NAME a IN . E.»...t..,...J
<br />A•.w ••.•NSI
<br />MI. oNOECEDKw•,il,l
<br />a. Green Count
<br />,� Mast,
<br />Iowa w U.S.A. ,D. Married
<br />11 Helen Richmond
<br />SOCW SECUMT
<br />su*A 0C „ TND OF W9NSS at "Muslim
<br />r,3b
<br />COUNTT0IDEAT„
<br />•f M Sh. www A rwN.MJ D
<br />u. 480 - 1664
<br />,s • Laborer Construction
<br />,.. Hall
<br />CITY. TOWN OR LOCATION Of DEATH
<br />D/Eg.Et,Cm tM.NTS
<br />HOSMTAt ORO f1Nff1TLIIlON- Nw..•(M..r.w w:TA... n"OW 00.61 TA•;..,. ROA.
<br />� - r���
<br />, Grand Island
<br />IA Yes�NwJ
<br />;r St. Fiancis Medical Center Em y oom
<br />,.w ergencR
<br />Is. Nebraska IS► Hall iIx Grand Island j,s.1316 So. Eddy Street I; �.1i,s "•J
<br />r;A - —woaE
<br />LAST I N -woof NuT -illr3 LAST
<br />.1•. Fred Gliem I1, Estella Breiner
<br />WAS DECEASED fM IN U S. AWED FORCtif i INIdRIAAMT - NAME - BEU,!ON6HP - NAMING ADOEESS ISTWIT W e 10 ND . 0" M TOWN. 11.11. EP!
<br />IE.Yes: 9 -18 -42 3 -22 -46 WW I 'Iw Helen Gliem -WIFE -1316 So. Eddy-Grand Island, Ne. 68801
<br />WMAL. C..w.N... 4!....1 DATE j CEMEIERT OR C1110 "1011m - NAME LOCAT,ON CITY 06 TOWN STATE
<br />x.. Burial ub. Aug. 30 19862a Cedar View Cemetery y_ L— Doni.phan, Nebraska
<br />• a IN r / 7� FUNfMAL HOME - NAME AND ADOMfSS (SNIT De 1 r D No C." O. TOWN. SWAN, 111!
<br />21 (VJT, A fel- Butler- Geddes- 1123 W. 2nd -Grand Island, Ne.68801
<br />�f "Y"! 1( _« DATE SIGHID IM. D.1. T. 1 HOUR Of DEATH
<br />-
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<br />uN. c �fi :s,cIAN of c wT Ar1oM+en L1rr. �J
<br />Duane Baker N.D. St. Francis Medical Center, Grand Island, NE. 68801
<br />DA.E WINID IT KGtST4AA (M•. DAY. rr.J
<br />SEP
<br />PART IRMATE CAUSE !ENTER GMT ONE JS PER UN t•b
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<br />�:E• _ - EXtfIRI1 i1 T.11.-
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