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<br />STATE Of NEIllASKA-DtPAIITIi4EIiT Of HEALTH
<br />8 BUREAU Of VITAL STATISTICS 84 04485
<br />Dt<fl>CH1-NJ - ,.20642 O___...;~!TlFIC~!~~F DE~~H_/ toXn5i-OtTH-'Mo-OO'--'-'-J- ________
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<br />_b-__--.M?j:'~in Si~ney___~~c::onn~J,A__~ iL!I~al~_ J~il 15. 1984
<br />1rA",1! -(..,. W-tI,,-,. Ilecl. ~"... OIJGIHIOlKINT ,_ . .Itali.". AWau,,_ lAGE u..o ......~.~ ~_y~,P!~.I_,!~~...-~~[)!I!_!J?~!~ CAlf: Of attTH (Mo. Da,. 'f,.'
<br />--,..,Jlb"",, "--.,..."......"', i. ;"", '''os, DAYS: HOU", "'HsIT 1 29 1910
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<br />. N b a ka ....i.!..... U.S.A. Ilg, Married lit Irene K~llham
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<br />USIOtHCE-STAT[ ICOUHTl' F' TOWHOlIlOCATlON i5TlflTAHO..UMtflr l~c"'-
<br />,,.Nebraska IrSb Hall !u..Grand Island :,.1420 North La!a ett ':50 ...../
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<br />The t... \_111& dellerll1ted real ntate (Be .efined in He.. an. Ii~.t.. 76-.itl).
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<br />Lot three (.5) in Block Eight (8). Harrison liubd1vhloa " the Oit7 .t car.....
<br />lelaad. Hell~l. Mebta.ka.
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<br />WHEN nils., COPYCAR,JUES THE RAISED SEAL OF THE NEBRASKA STATE
<br />D!:PAM'~ OF HEA1.~H, IT CERTIFIES THE ABOVE TO BE A TRUE COpy
<br />OF A1'f ORIGINAL RJ3ctnlD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF, ,vrrAL STATIS'1'lCS. WHICH IS THE LEGAL DEPOSITORY FOR '
<br />Y.ITAL 'R.D:OlDa.
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<br />DIRECTOR, BUREAU OF VITAL STATISTICS
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<br />h~ued Nov. 27, 1984
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<br />LINCOLN. NEBRASKA
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