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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE 85--001264
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE- CUP76_
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT O ,H j;H
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPO9IT0it.Y Tr0F•.a'r
<br />r' VITAL RECORDS. -
<br />DATE OF ISSUANCE
<br />A)�" FEB -
<br />1 -
<br />1 STANLEY S. Ci?�P�Rr :,DIRI;CT(lR ,; i
<br />LINCOLN, NEBRASKA BUREAU OF VITAL�YC$` ' -
<br />.J
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH
<br />ME" OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH ,� ?
<br />M -NAME !I!1 IASt sFR —� DATE CN
<br />!. Grace Jeanette Olson_ emale , January 29, 198_5
<br />f -N y.. WA;N. B4lL. A w.. 01*"DISCEN ►f .g- ,frol;s., MdR;.a�w. AGF t.a f.n•d.r UNDER 1 YEA, UNDER 1 OAY DAtf Oi RNTN (MO.. Oa Y.
<br />ArdNw, MY -D rspdr;f,/ f:•.weR, fk.)(Sp «drl TnJ MOS DAYS' N---- HOURS,- MINS Y. 1
<br />d White American !; 70 (� I� ,July 25, 1914 _
<br />(! A1/p TATS W BIRTH (N .ror iR U.S.A., CITIZEN Or WHAT COUNfRT MARRIED, NEVER MARRIED. I NAM[ Or SrOUSE (N.;a. gi...e..d.....a.)
<br />.roa..e.Mry/ WIDOWED. DIVORCED (Sp-1j;
<br />R Kingman, Kansas `` g _ U.S.A. )D Married I„ Ivan E. Olson
<br />SOC /AMCURTRNUMBE! U S U A t OCCU PAT ION (G;• Li.d.l.arE den•dur;n" p- i�w�+�EIND pl RU SINESS W INDU5Iii COUNYY O /OEAIN
<br />,2 440- 07 -4216 1 D Ha 11 3b Hall
<br />—J-_ ul, Domestic
<br />CITY. TOWN Of LOCATION OE MAIN IN SIDE CITYUMII$ MOS►+ TALCROTHIRINSTITUYIO N- N.— ii(— .,.r.rrL«. 1 +1fQY Of ursl l.dK.ro go•.
<br />Grand Island rsp..;r�Y• ., NR) g„rZ.RN Rnd RY f.r D.7a, +.•it »• M ,.,•e..rs.ad,,
<br />! Tk. es ," rand Is)'and Memorial Hosp. ,dp Inpatient
<br />RtSRNC! -STATE COUNTY ' CITY, TOWN ON LOCATION - - - - -i STREET AND NUMBER - _- T1N51pE CITEUMITS
<br />T7.. Nebraska I.TeB, Hall Ilk Grand Island ue 2503 Park Drive !(sp «.rrY., s No
<br />1 - - - - - -- s< Yes_
<br />A - MI —" LASfi- THER -MMRN NAME fllST ZDDLE LAST -
<br />T� Henry D. Endicott �, Jennie -- Davis
<br />WAS DECEASED EVE! ttd U S ARMED /CMC[ST INFORMANT -NAME � - RELATIONSHIP - MAAING ADDRESS 611111;0_8 R (D a0 Un oR +Oww. A•TE, ial
<br />,.... «..ulm,.. p..�. - d1.- .,......i 6801
<br />u N® _mow Ivan E. 0lson- Husband -2503 Park Drive -Grand Islan , NE
<br />- - -- - - -- - - ---- - ---
<br />RUMAL. Cr.Reewon. R.m.. > /IDAt ! CEMETERY OR CRIIMTORY -NAME �,' (OC AYION CITY W TOWN STALE
<br />2, Burial ? Feb. 1, 1985 i7o+ Grand Island Cemet� _ 7od Grand Island Nebraska
<br />-SMNAT IKfNSf NO i/ FUNERAL NOME -NAME AND ADDRESS WI
<br />uRj+ �C - - -- — - — — - — - t+ne! of ! r D wo an of TOWN. siATe tNr
<br />!72Apfel_Butler- Geddes 1123 W. 2nd, Grand Island, NE.68801
<br />ohm 00 b" Y -- - --
<br />.=F DATE SIGNlO (M. Dar. Y.) 'NOUf Of Dt1TN -- !_ - - -�
<br />Ids
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<br />iYd�6 AND R -F j�j{� N CON ►NY }6[!AN OR COUNTY AiIORNE /) II,pR a• I.rn.J - - - - - -- - - - -�— - - - - --`
<br />G, 5THrnicek M.1f. 729 N. Custer, Grand Island, NE. 68801
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