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<br />WHEN THIS COPY CARRIES THE RAISED SEAL, THE NEBft A')V ATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE;A,TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE- DEP T,,OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAi: •D'Hfs37$i• .FOR.
<br />VITAL RECORDS.QL' 004131 - t
<br />V V'�
<br />DATE OF ISSUANCE
<br />JUL 1 705 STANL ,Y- S. COOPER {, 3�RSGTOR
<br />LINCOLN, NEBRASKA BURF." V t.YL XU:S''-I ICS
<br />STATE OF NEMASKA- OE►A"UM OF HEALTH
<br />SUK" Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />wmw-m&w rat AU —L-3A T ISIX w . Z>TbTwIN n.,. Da:. r..• - - --
<br />Arthur Daleness I. Male I, July 9, 1985
<br />RXCII -N-D.. AMIiw. ENT(. 8.•INIi.w,M »:,r.,
<br />AGt- Lrf:My.,
<br />UNDtRITEM UND611DAr DATE OE BIRTH(M.., D.Y. r..)
<br />I.il.(...4J(Sp »U,.) Cw.w.., .k.I(SP»if7) O /-
<br />(Y..)
<br />MOS. DAYS HOURS • PAINS.
<br />.. White -American VV
<br />60
<br />ft
<br />K. .,. Feb. ,. 23, 1925
<br />CIIV A A ( 1..f m U.S.A.,
<br />Cl/IEtN Of WIT O{IN , N RMA111lD,
<br />NAME (If.W.. 0-
<br />.w •...b7t
<br />WmawtD, DiVOKtD(Spwar)
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<br />Qr North Dakota
<br />P. USA ,D,Married
<br />,,.Vera Plenty Chief
<br />SOCIAL SECURE" NUA411101 IV$UAtOCCUPATOON(Gi..k;.df.-6d.-dLwig-O RMIDOf
<br />BUSINESS 0R INDUSTRY
<br />COUI4TT OF O1ATN
<br />N-N./ wh. — II n.wN4
<br />FAIR
<br />It. 501 -24 -9060 11 . Truck Driver ubConstruction
<br />Co.,,,,
<br />Adams
<br />CITY. TOWN ORtOCAT10NOF DEATH
<br />INSIDE CITY UNITS
<br />NOSNTAl Ot OINER INSTITUTION -Me~ (If. f,. ..Ib.., .HOlI bIN{T I.Ia«. DDA.
<br />I3.«�I, r.. ., NCI lIAWHfR CM CDfONIf
<br />tsP»�T YN «If.J
<br />Yes
<br />Biw.I•.N.rl ..i«) QrNr:ww( /er. r.l 1.�.+ 16—JO
<br />Mary �,anning Hospital Inpatient
<br />.Hastin s
<br />,4.
<br />,AR, I,..
<br />wLDENCE -STATE
<br />COUNTY
<br />CITY. TOWN OR LOCATION
<br />STREET AND NUMBER
<br />IN $IDE CITY LMNIS
<br />,R.. Nebraska
<br />{x. Hall
<br />IS,. Doniphan
<br />,s,. Rt. 1
<br />(Sp»:f, ..-N.)
<br />IS., loo
<br />A U
<br />N 1 -MAIDEN N IRS MI U
<br />,, Ole Daleness ,
<br />Sina Peterson
<br />wAS DKtABD WER W U.S. ARMEO FOKEST
<br />INFOMIANT -NAME - RELADONSNIP - MAILING ADOR(S3 IST11I11 [ft t I D NO. CITY OR Tow H. STATT. Pri
<br />IYr• r, « w•1 IN ,w. M•'• •.1 rl1 MI.. N r.••1.1
<br />,B. No - - - - - --
<br />,•Vera Daleness,w_i_fe,Rt._ 1, Doniphan, NE. 68832 _
<br />WIIAL C..w.N... R..r..l
<br />n.. Burial
<br />]Bb. July 12, 19852BlRosedale
<br />ClME1tBY OR CRIMATORY -NAM# I LOCATION CITY OR TOWN STATE
<br />Cemetery 12". Rosedale, Nebraska
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<br />FUNERAL NOME -NAPA# AND ADDRESS (LI»LI O. f 1 D NO. C•A q IO N. $—C. IMP
<br />Hastin Nebi•g,5l�a 68901
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<br />],.Livingston- Butler - Volland Funeral lome,ll North Elm,
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<br />A GN (M. Der. Y.) HOUR Of DlATH
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