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<br />"FY.TNr INK SLATE Of HEBRASlG_pEPARTIAENT OF HEALTH (
<br />~rAD[rR1N BUREAU Of YITAI STATISTICS
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<br />-~ i hazel ttTrpuL.rite (eil Ir ternaie ~anuary 9, 19$2
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<br />AND Sf 4 ; RlA7H Ht nvl in U.S.A., ~'[ITITEN Of wNAt CCtUtd (RY MARRIED NEV{R~MAR41tU, ~-~~~ NAME Oi SPOUSE (1{ ;f, 4.r~ ~,~nnn'n.j
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<br />E_Elbat ,lebraska ~y. t.S.A iq t~:lrried I11 Idarren D. Geii
<br />r $OCiA1 SECURITY NUMOEE U~SUAi OCC7fPAT1ON 7C i'nd of werl dnnv do- ~ .1 KtNq Of AU51N!$S LSq INDUSTRT COUNfY Oi DFATN
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<br />[t7Y, TOWN04COCA'nON O; DEA'iH ~"~ijN3lDE CITY1Wf75 rH45Ptta ijR OTNER INStUUiION Nom. (ll nvl rrc nln.r. F 03R O41N3i: tnd.m pqA,.
<br />~ tA4. Grand IS sand- JTP ~Y v.N i y d b.r1 Ouepari.nUFm«-Rm,»P - T.s:yF
<br />.-.. i~ s ~, , Liii~lerizz atnorial 3lospital ,,, Inpatient
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<br />CITY, POW OR lOL if4F ~STAEFT AND NUMBER INS4D[CITY IDAITS ---
<br />"' . ~ isa. Tvebraska Tsb hall i (sw a r.l.. N.)
<br />_T_____ ,s< (ranL; I ,l and ~ isa. 1€321 61. l.puise ,,,, des
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<br />,~ _ ., i° #ClisiiFRY OR CREMA"ff3IIY ~H,iME -~~pCA(ION CITY OR T03VN i
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<br />' ._;D, --$uE'1al`° ~~" zFR" (i•<•tnrl~••i-~l ~lnLl (¢neterv ~aqd. Grand Island, NE.
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<br />R. B. Koefoot PF. D. 727 E3 Cusstcr, GraTd T;land "F. 6$1;Q1
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