|
I
<br />'AM THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA; STTATE 1 00001
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE.COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DBP4Y QF;HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LE9X DEBT 'FOR
<br />VITAL RECORDS.
<br />" rt
<br />DATE OF ISSUANCE
<br />SEC 1M
<br />1 rI STl13lf•_S, C(iOP�'!t;_1��RECTDR`;
<br />LINCOLN, NEBRASKA BUREAU OF VITAb ft"ArTISTiCS
<br />STATE OF MEOW=- sEPARTMlNT BF HEALTH
<br />MIKAM OF WTAL STATISTICS 85 08696'
<br />CERTIFICATE Of OEATH ,- _ %;
<br />01GMNW-MAW Avow
<br />Nawice Charles Cantral
<br />Male July 2, 1985
<br />A A.aY..
<br />r.....xE.•• . /Wtsiie
<br />o..�s.�
<br />II / 1, o""75
<br />ros. . a ra
<br />Mows . rs.
<br />A1�S'1C /�
<br />,. Ibbr. 22, 1910
<br />•ors.�.,1
<br />- a C llebrasim
<br />,_ USA ,
<br />a
<br />n Elm Jackson
<br />oaftvvcvmw�
<br />rc1../�.+.r.Wra..I.a.,W.r ■fworwsfMIM00oufnr
<br />COUNno s"ir"
<br />M 5 -136=73
<br />,deer
<br />ur. 0 /
<br />IN!% Nance
<br />CRT. TOT.N an LOCAna" Or 04M
<br />1049W CRt OORi
<br />NOS.RAI Of of"" 14TN0T10N -Nw. TM.M:..:Mw, w pp.:pmm, rAw 00+\
<br />Fullertoa
<br />fsr..ar N.1
<br />re7s
<br />,.w
<br />-man Meaorial Hospi Inpatient
<br />,.,.
<br />, :'rdT%m ,..
<br />mesm"10E -SLATE
<br />CM. TOW W Of LOCATN>!1
<br />STAEfT AN0 "O,A M
<br />,NYOE CRT uwn
<br />Lou""
<br />u.. Nebraska in, Nana
<br />,k_ Palmer
<br />,,.. Rural
<br />Charles S. Cantral
<br />U. -Clara Books
<br />1M113 rECd m ON 04 U.L.AMYe bOCit
<br />a.. ,....a, w ,.. .r r.r..1.!
<br />0M MAM8- NAM[- &RAT10NfM11- A%AAMG ASOOM 01=0 CM &1.0. NO_ do M TOWN. RAM S.N
<br />,,. Elva Cantral Wife Palmer, Nebraska , 68864
<br />WSW. Cm. Am
<br />COWMWOOCOlNATOW -NAME
<br />LOCATON CRT Of TOWN STATE
<br />a.:' ni. July 6, 1985
<br />„k. AL13.erton Ceaeterp
<br />C. R lerton, Nebraska
<br />PUNOW NOW -MANE AND Af00ESS am" of al 0. 1101. CT oA /f11.1, RAIL an
<br />PalmrEs Ameral Home Phllerton, Nebr. 68638
<br />wum m&. EO,. ►rr
<br />..1
<br />July 2 1985
<br />-
<br />s�
<br />2" 12W M
<br />July "
<br />noNOU"=89*e roogouMCE0 oEA0tN.w1
<br />'A'' - ''r •• '
<br />12,55 P••M
<br />i
<br />.w ,I«eW rwr
<br />O. rVi. d .«.i..�.•Mnb"..I,..�.b.► «bf«4.. www.iM
<br />_...+taws
<br />ZZI
<br />u
<br />A
<br />H..irw•w +.rr�u�
<br />r .....
<br />-,A C.L. Sweet,M.D.. 209 Broadway, Fullerton, Nebr. 68638
<br />Arrest
<br />r.,.........r.«&
<br />min.
<br />•+ Pneumonia 3 days
<br />Metastatic adenocarcinoma of the Drostate 6 mn_
<br />
|