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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />r DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY <br />I OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR <br />VITAL RECORDS, 006.1 <br />85- 27 <br />v V 1 <br />DATE OF ISSUANCE <br />MAR 6 tti 5 STANLEY S. COOPER', 0,34LECTOR <br />LINCOLN, NEBRAS %r '7? -L, BUREAU OF VITAL tTAiISTICS <br />RF�;ORDERS iJtMLi - `!! '� , �% ,✓_„ ,: <br />sill ;:,....� 4 r AeY d Dtads <br />r�q -7wRSt s*sv rsil STAIR OF XZMASKA <br />DLTA7lT>rn ! 60 TOalx XCAL'371, DErARMEM OF REALTH <br />I w.T.TraTTpg A](� M I TARS mb-w am of Vital stathum 61 0176:1 <br />mxm I[D. 129...»... CERTIFICATE <br />OF DEATH XrATS tray <br />rw - wc(wa....wdb L a.... ..r....�.w <br />T. Da.s or DnTn <br />.. I0IMT I- err <br />n 6. COWTV <br />� Vebr. Hall <br />Hall , <br />0. GOT. 1Ow14 0N- tea(Trew <br />t. LX Of STaT M 1► <br />S. un. TOwN.ON LDCaT10w <br />Crand Island Nebr. <br />53 -r <br />Grand Islam Nebr. <br />!. lYr[ >K IA a.f IaYII MM .Mr.wl <br />i. 5711[[7 ADON[SS <br />117 k. 14th ft. <br />117 ',. 14th St. <br />s. A.TaC[ Np11r TR ND <br />.. a N[SID[NC[ NISID[ CrtT LIr1TA 7 f. TANM OLl/OEIIt[T <br />NO <br />7 .IaNx M INwI A/U/I LAW &. an at" ,•T tow <br />`te w•r rebr. 22 1961 <br />/71yNejriNl) John r <br />AA�'7 <br />. S[t L COLON ON Mt[ 7 rMDfDy 11[MI MIIMKO ! rrN11 T.aN - IraA.�.ri. <br />1�19""MI a..r. 4 r... arz. <br />Febr. 1P 1?92 <br />!Male White wwom' aTDNC[o s <br />Nh. MIILt O[CYMTIOr (Ol.r Nwrt �. IN. IIIIIOOi DYSN1[SSON NNMISTNT 11. DNITwK11C[ (we K mwwn @ ew . C111�I I wwT �Or.1NTr <br />C>"w IMr, wrN M..Mr+► <br />operator s- g Union Facific ?i. ! . Germany USa <br />q.. M7wp17 a►IIS li►.rD7w[N Ti ra/KN'war[ K "m or NOSOawD ON "" <br />Clara E ('%der; '.:ever <br />John <br />waS OK[aKS'p[w w L I aNrp NONC[ST <br />A. TOCIK UMM ND. <br />17 "women awT <br />712 -4609 <br />':rs Clara Lever Grand Island Nebr. <br />ro <br />--07 <br />W sal" M *"TIN tOas.NN.N•..r.r ie IN. 0). And (Il.l � <br />Ni[i�awDD�[atii <br />MNT L KATO w" taum OT+ <br />— <br />N..KDNy10 CaY![ L1 n �, <br />} <br />SW su[ TD te) <br />MDT N OWN M CONMT1aw Cr11NwIR1w. lD ,[aT. Slw 1..I .l4RD TO Tw[ Taw.wL 0"m COmwrt ONSN w M>tT II.) <br />RIq'OOr[01 <br />T[f b <br />!...CUKOT [DICK[ I10r1CiK <br />Ki KSCNIK wow aiwav DCCOIIN[D CAP- <br />0 D O <br />Kr TIME or umr N owL Do. Y..r <br />r1 NMT a. 1w <br />N... <br />8 <br />ii <br />>II/ N.NNT mrr, N - a[I- PLmm Or W MT N. v.. IN M ~ Mrr, C1TT. TOW ON touTON COIMTT STMa <br />13V <br />t .O Q No �. jww /rl q. rrM. *AM MM.. ON.) <br />NwN M0 <br />to " aw11Nu[a.w aiMM �i <br />tI i.tMnd;d1o.dswe"d <br />w`]n the d.N N.Nf .iwa:.Al N tM MN d UV IwMfsd&. Mw HN/Nr IM Na[w. <br />am"* a/we"d at. MT[fMlt! <br />11. 01N..L. <br />!� RR L71. NAML Or ENTRY 011 ON[raTONT no LOCATOR ([.[If. M WOO <br />' Al 1- <br />2 -45-61 Grand Island Cen►ete Grand Island Nebr. <br />r[ Kp M NLOISTwO <br />T,NTN <br />"[ N , <br />i. A NrA [ e- ` <br />S <br />I- Gaand Ialm d, Nebr. <br />ri <br />M 27 11:41 <br />