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86- <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A'T-=t-"tbPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPAJMW"T'bl"?:i1EALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL, bool�1 Y-.FQA. <br />VITAL RECORDS. <br />DATE OF ISSUANCE <br />DEC j STANLEY <br />OR <br />LINCOLN, NEBRASKA BUREAU I; STICS <br />Lot 7, Block 20-1 <br />STATE OF MENU MA- DEPARTMENT OF NEALTN Original Town of <br />SMAU Of MAL STATISTICS Alda, Hall County, <br />CERTIFICATE OF DEATH Nebraska. <br />I � T� , <br />secow"I NAME not MA ME LAST is DAM DEAN Im.. a". V. 0 <br />Janie M ! Female- i, Nov 13, 1986 <br />rile Wiese 12 <br />sha-% 0. ww", &I-*. A. J�Scffmj. AGE - ,..rte.. i UNDER I YEAR' UNDER I DAY i DATE OF IMITH (M.. D." 7, <br />dk 1, Oct. 4. 1916 <br />S 1:7 DASI' : <br />whit German 70 I <br />OrFF am STATE or MEN (0 d✓ m U 5 A. cou"M RD HAAN <br />VADOW". OMMED(SO-40 <br />Barboursville, Ky. C,' UUN Or V'A' „R married Kenneth Wiese <br />SOCIAL XCUMM W%Naff VFATN3NfG- OF SUWHISS ON &NDUST " co"N" <br />Of DEATH <br />285-18-5321 13. Clerk 113U Grocery Store iHall <br />CRV. SOWN 04 tOCATION OF DEATH I RMN C"V — "OS"TAI 00 OTHER MS"TUTION - M� fff — w*w. 0 MOV 00 041 � DOA. <br />Isp-4,►. .d .. &�# 0~-1-- t"i &� <br />..b Wood River it. yes -N-) lf-w=ood Samaritan Center inpa ent <br />199100mcf-STATE COU"TT j C"V. TOWN OR LOCATX)N I STNET&MNUNGER INSIDE CITE I.WTS <br />Nebraska lo9b Hall ItS, Alda IM104 W Front <br />- <br />11 ;&W 'M' MIME LAST I OTHER - AWM. IF Wr -MME <br />Louis (unk) Vaught !U Gertie (unk) Jones <br />wAE ..o em He v s A&%** mK*sr-----Tm—FowApdr - REIAt1OPISNN - ^"ING ADM SS 151-0110#010 I.O.CM0910—SIA11.1l <br />yes 1 1943 - 1945 — I. Kenneth -.husband 104 W- Front St Alda, Nebraska 68810 <br />jC"QT1QTO@CRf^A1OxT-ftA01 tOCATION ciry OR TOWN STATE <br />n.- Burial Imb Nov 17, 1986118, Westlawn Grand Island, Nebraska <br />Imem"M - Sop""M a LICENSE No TUMMAL HOME -MAAQ AND ADDRESS 41101T 00 ft # 0 .0, CM Of 00 w STATE. 21ft <br />(7b <br />Apfel Funeral Home, Wood River. Nebraska 68883 <br />U" OF <br />REAM (AI. -. 0-- g( - I DAM W-H*0 f". 6". T. "OUR OF DEATH <br />Al 23h.- k 0 V e- ia. 2.b <br />RATE W.M9 14A.. D". F.) tR�i ►90"Ot04CED DEAD PRONOUNCED DEAD (H—) <br />1%-I 2k. �0100 A9 AQ lu <br />&06� Stewed Lee Raven, N.D., 2310 V. Phoenix, Grand Island, NE 68801 <br />facant"(m. T") <br />24 <br />PAN cum (INAFROW PER FOR fe). (100. AMD (C)P <br />t, A C1?1�111 lt__.j <br />EXHIBIT "A" <br />R <br />