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STATE Of ►- P&AWTUM oF le vm
<br />WJKAU Of V1TM STATISTICS 000258
<br />CERTIFICATE OF DEATH
<br />N IA
<br />IX
<br />DATE OF DEATH (Aso_ Da,. Y• )
<br />Mar Frances Sanders
<br />IS
<br />Female
<br />October 15, 1984
<br />(R.R., WNdM, ►, ARNHkaI OHGM►JOESCNNT (R. ®.,IMliea,MNNaI, AOE- <.NNRwMM,
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<br />, NTJ fSARYifq ORNw,RTe.IfSpR<I(P) TYn.l
<br />MOS: .. DAYS HOURS; ANNS.
<br />White American RR. 86
<br />ER (� , January 29, 1898
<br />A AN in V.S.A., CITIZEN WHAT COUN R MARRIED.
<br />NAME O SOUSE (H.ih, Biw reJIRR AR«R)
<br />eap.,) WIDOWED. DWOIKED f Sp «.y)
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<br />mond Nebraska , U.S.A. ID, Widowed
<br />11
<br />fKUR"rft%BER USIMOCCUPAi1pN (Gin lri«I alRert dRnR dwirly ..R<1 KHRD
<br />OE BUSINESS OR INDUSTRY
<br />COUNTY OF DEATH
<br />.erE' lip. RnR i( )
<br />Cosmetology
<br />Hall
<br />6 -40 -0334 r ..%R Beautician 136,
<br />,,
<br />r,254
<br />WN OR LOCATION OP DEATH
<br />INSIDE CITY LIMITS
<br />HOSPITAL OR OTHER INSTITUTION- N.—(#I iwr i oalMal, I MOREMINa1I- Ik—DOA.
<br />Grand Island
<br />(Spo<f YM M HS/
<br />yin�Re a.{ �6e� 1 O. P.19 —VI-P, 6.. I.P.N.w• ISPrdr)
<br />Island Memorial Hosp. Inpatient
<br />IRe.'es
<br />r .l�randA ,,,
<br />HCE -STATE COUNTY
<br />CITY, TOWN OR LOCATION
<br />STREET AND NUMBER
<br />INSIDE CITY ZMVTS
<br />Hall
<br />Grand Island
<br />310 W. 4th
<br />f3pe<.fry He)
<br />�@s
<br />ebraska 1$.
<br />Is
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<br />,�.
<br />- U
<br />N -ORAL EN NAME IA E U
<br />Vincent Cihlar
<br />Christina -- Pavlick
<br />,
<br />DECEASED EMIR IN U.S. ALMEQ FORCES?
<br />INFORMANT- NAME - RELATIONSHIP - MAILING ADDRESS ISTREEI OR R.I D. NO. CI OR towN. STA'E. ZVI
<br />r . AI IN M Riw wr ..R RN« N ..,. +rN I
<br />I9.Cornelius E. Bohart- Son -4206 Frances St. # 8 05h, NE.
<br />ButlM. C•amNEee, R.r...E
<br />CEMETERY OR CREMATORY -NAME LOCATION CITY OR TOWN STATE
<br />Oct. 179 1984
<br />>a..Butial 30b.
<br />2D<, Westlawn' Memorial Park ITOd. Grand Island, NE.
<br />ENSE NO.
<br />FUNERAL NOME - NAME AND ADDRESS (STREET OR JIVD. NO.. CITY ON TOWN. STATE, 110)
<br />Butler- Geddes 1123 W. 2nd, Grand Island, NE.68801
<br />2,Apfel--
<br />DATE O!A f .. ORr. 1
<br />DATE NED (AM. De,, Y•.1
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<br />246.
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<br />NAME ANO EE ( IAN, C ECS ►N AN CO NTY A N
<br />C. D. McGrath M.D. 729 N. Custer, Grand Island, NE. 68801
<br />IRA!
<br />DATE I CC ED BY REGISTRAR (Me.. D.P. Y•.)
<br />CAIN ENTER V ONE CAUSE PER LINE FOR (.). (6), AND (<)I ' r ....N b*P— ..R d-*
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<br />DUE TO. OE\ AS AC994 MUINCI IIIIIIPPP W.- M
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<br />wAi CASE -PERRED TO MEDKY
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<br />ACCIDENT. SWIDL NOWCIOL UNRET.. DATE CH uULNY (Mw. D.P. Y..)
<br />Noun Of Iwun of
<br />SC MOw IwWV OCCURRED
<br />OR ROOM 4RalR1NDATIWI. ffp «N,)
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<br />300. 30►.
<br />30R. RA i0d.
<br />0" AT SIIO�
<br />"ACE OF RRIURY- Y LOCATION
<br />STREET 00 S.E.O. N.. CITY q TOWN STATE
<br />r V. r INN
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<br />70f.
<br />RECORDERS MEMOT. '( 7 ` / v{ T p r
<br />Cop,r`tuRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DE$ T'0F , IT CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />01r" ' , ,ORI ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />V u�TJSSTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />issued Oct. 23, 1964 a
<br />DIRECTOR, E3UR]EAU OF VITAL STAITISTICS LINCOLN, NEBRASKA
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