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<br />85- 004718
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW.TO:BR,A:.TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE 1104 PWT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LE"V,;'1EP6ftTORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />SEP a
<br />S 05 - , SZ;ANi."$Y ' S. COOY7�; DIRECTOR
<br />LINCOLN, NEBRASKA �BIlREA11 1►'. V#T`At STATISTICS
<br />STATE OF NINASM - OL/ARTMENT OF IIMT11
<br />K"" VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />Sto Natham Smith -- ..,
<br />- _____, - Male -, Se tember 5. 1985
<br />.w. .4JISM•.yI ..USj ij ��INIi.w. M•�islw. AGe -f.w A'^yr E r rlA� u 1 r DATt OF Nff «rW.. D•,. r..l
<br />A White / G rrb.l mos. DAPS Hoofs . .wrs.
<br />American 79 w.
<br />! N WHAT COUN ,May 10, 190
<br />Nf w•, :. Y.S.A.
<br />'.....•i WIDOWlD. D/VOKror1. «,y, J� tw M...N." —i
<br />York Count Ne. U.S.A. Io, Married �ppyy``
<br />urn uSUAL OCCU.AT1pN rGi.. i:•/ •r...3 4•• d_,o, •,..r EINp W DYSINfSS q INOU3TN i cOUNfre n Db e r e r
<br />=508 -26 -•r -•.Iwy 1.4....w A rNi.N,
<br />3744 , Steam Fitter
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<br />TNSW CITV Lw#TS NOSMTAIO1 O . IMTIfUT1pN -N.r• rMwM:•..M.r. ,. ,qfl q.9r. ..n,.,. oOA, Dcaste
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<br />IS. Nebraska' - Hall
<br />►LRATR1i17- "— �"'- --
<br />16 Charlie
<br />WAS DECEASED EVIR - U.S. AMMO FOECE31
<br />Is No --
<br />NUMAL C..r.:•w. bw•..I
<br />Sept. 9,
<br />Ts. 8urtai 7E►. 1985
<br />?sv September 5, 1985
<br />-� .T,1, September 18,Y198
<br />now
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<br />Scott F. Liggett, M.D. 100
<br />n emorial Hos its N.. In atient_
<br />CITY. TOWN W LOCATION STREET AND W,
<br />INSIDE CIT1
<br />Ik Grand island /u2226 North Howard s; «�rYre
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<br />Smith Emily NEAMMNT -NA•U _At7. Folts
<br />WIFE: Josephine Smith" srneranD o c,n «TOWN.sl,
<br />.Zn« N -QX'hLLH.w ard rand Isl_And,_Ne. 688
<br />LOCATION CITY o, TOWN Sl
<br />lestlawn MeiDOrij__p 10f Grand Island Ne
<br />EE;I"0* - -Niwt AND .�01 S nrEHl DEErD NC can ro'.'N.v :D) , Ne
<br />APFEL- BUTLER- GEDDES FUNERAL HOME
<br />1123 W__ 2nd St Cranrl Zs1a14 Ne 68801
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<br />10:00 p N I •`r i.k /8S I =N 10:00 IT
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<br />56th, Ste. 407 Lincoln, NE 68504
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<br />Cardiac failure
<br />' ��bi+ E�'► �;' si' 3" AfbiiiNti' t17_._____.._.__------.-----_----..
<br />__-- ---_ ________ __________.._._
<br />,., Coronary artery disease
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<br />Kidney failure
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