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<br />STATE OF NONUM A -W*&rf ENT Of NEAITH
<br />OYNEAY W VITAL fTATI:,W: 86 106099
<br />CERTIFICATE OF DEATH n_ yam- .
<br />-01CIOM-MARIF POINT NAME LAST
<br />SIR A (M.. D.T. T,.l
<br />Laurance Leonard Olson
<br />1, Male June 5, 1983
<br />WrA -M.F, AM..i..• ORIDM/DfSCENTN1.q.. I..I:.., M.P:.... AGE -L•N S-w- u I OAT ' DATE OF SIRTN IMF.. D.,. Y. /
<br />/ •AIE.Il3PM+,i (Yn. MOS. DAYS I HOOK • AIINS
<br />American %`: �6 ' : ml, Oct. 16, 1906
<br />CRT 00 STATE OF WORTH, M .0- Y.fa.. CMZI! Oi wHATCOUmm RMASHED.
<br />NAME OF S►GUSE(IF de. Or— r 4..-1
<br />Nebraska L.S.A., rDie�D("!''
<br />Susie Benjamin
<br />e�iic ngton, ,
<br />„
<br />SECIERTFY NYMSN
<br />USUALOCCUFATTONI'G:..6:.f.r.wS J•w l.r:g.T•TT l K]NDOFOUSINESSONIMOUSTET
<br />COUNTT OF DEATH
<br />712 -07 -3641
<br />1 o�nETu"c`o " ;- 1131?. L.P.r.R.
<br />Hall
<br />,
<br />y'(,r
<br />,M
<br />CIER,fOWMOlSOCAiION OE OE AM
<br />tMS10E CITY WILTS
<br />HOSPITAL OR OTENR UYSUTUTION -H." (if .M:. FNM•. NHOW OF NPST I..:tr. DOA.
<br />lip•c�"E YM r PN)
<br />I
<br />s:w ..I Ti o.r.T:M}Fw, r, I•r.+.•l rF.«M
<br />I
<br />E Grand Island
<br />,4 Yes
<br />,AA t. rancis Medical Center,,,. Inpatient
<br />gemmemCE -SEATS 1COUmIv ICIIV TOWM*OtOCATIO% StEEETAMONUMEES CITY LIMITS
<br />EEINSIDE
<br />Hall ITx. Grand Island �,,, 814 W. 1st 1;ss'f"`4res "''i
<br />,,,Nebraska ,„,
<br />A - LAST
<br />MOTHER - MAIDEN NAME FRCS
<br />Charles -- Olson
<br />Cr.,a -- Swanson
<br />WAS MCEAEED EVES IN U.S AMHD FORCES? I INFORMANT - NAME - RELATIONSHIP - MAILING ADDRESS tSTR(T 041 f T T D MO C 00 TowN STATE LVI
<br />«..F/ H � 1"+ "•I w •.M M ro.w..) 1
<br />h0 Olson- U'ife -E14 t:_. Ist -Grand Island, SE. 68901
<br />,s ;,.Susie
<br />lURIAL C.•Mw:.., R•MM•1 CEMfTfRY OR CfEMATORT -- NAME LOCATION CItT W Tow. STATE
<br />June S 19£3
<br />'
<br />3E. Burial 396 ,a Crand Island Cer:eter�_• Grand Island, Nebraska
<br />-, • j 9 i FUNERAL NOME - NAME AND ADDRESS (jTNFT OF FT D NO. C-T, ot TORN STATE E VI
<br />�(f
<br />r !,,A.p`el- sutler- Geddes 112? ;. 2nq, Grand Island, tiE.6S 0]
<br />OAW 9F M E r• T•) i DATE SIGNS /ATE. D.,. Y. I HOUR OF DEATH
<br />20, M
<br />_
<br />tMWR OF DEATH ;PRONOUNCED DE AD PRONOUNCED DEAD(HO..i
<br />J U:VtiL. (t fS 7 #73L ;'�G t _� ! 'lad
<br />tM. M.�.", ?_? 2aT
<br />i. IS• W / w L.•.IP•F . d-A -MO •. Nr w, 6- - F }w. Md a. ro a• 11 O 0. w M...1 •M..wn« ..F/.• ...•.T ,,.. «. ........... �.... .......e r
<br />. M...T.i .•M .. /� i M dry_ •.ro W Oi....w IM .. TIC. c...N,) .roroF
<br />,3i.(f:F•r.ro w/rd4) . r'u'in /r }� "V �1/ i /�.Y" i ..l �.'1 i�A• rs,yuM.c..nt t.M)O
<br />NAME ANO ADORE of CE IF (PHYSICIAN, COROM S PH T IAN OR COUNTY ATTORNEY) (1,.• or F. 'w
<br />S. T. Anderson 11.D. IF.11 I,'. Crand Islanc PITE 08801
<br />DATE. E1VED ST REGISTRAR (Ma. DoT. T• .I
<br />?N.(tF.•w+l�� // J
<br />7E CAUSE (ENFER ONLY ONE CAUSE FEE LINE FOR (o.. (61. AND (cif � :%� ro..I •rw« .ww..A l..w
<br />PROT
<br />DUf A CON NCE w. ...., •.+..
<br />M
<br />DUE TO. W AS A CONSEQUENCE OF.
<br />w
<br />SN: COH01igNS- CwA�,�.•S.n... ro A...I e...r .Ww r.n Ix N .EAAIE S T"I.E A AUTOPSY wAS CASE RTNRD'O wLd
<br />'..1fGNANC1 IN INS .AST j MONSNSI (SP.aA, T« a N.} TTYYNEf p CDRONEf
<br />■ YM : N• :� i 2t '� y i_ i 29x...4'(% � ,
<br />SJ
<br />A[GMM, f1IICNf. NOrIC101. I..Mi . DATE n .UtMT fr.. Ds.. C.O. Nuu.Y MSCUSE Now I UY, O'CU09D
<br />DS MMRrEf .NlSIIGATION tSMJFi i I
<br />�.. 306 i 30c M 130A
<br />_
<br />MII E AT W= I PLKE OF tMIUET - M lu... 1•..- MMt. I.n«,. ': LoCATIOH VRET Of R F D IM CITY CM to— STATE
<br />ISM.*Y.-He) 1MEN•6.:IR.4.w ff/.aarl
<br />309
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A.TRUE COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />_ _n ,
<br />MR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br />AF`NEBRASKA issued Jul 21, 1983
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