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<br />~~-"yj~(}b'~' '~ surrrau uE vcr:.r srar(sliu:,
<br />CES2T{f{CATE ©f DEAR E-~_
<br />FIRS MIDDLE 1A57 ~ SE%
<br />Harry Albert Alber ~T Male
<br />eY. Ampri<an OIIIGIN{DESCENTTp.R., holien, Me.iron, AGE-lap e:nMp. 7_UNOER t Tf
<br />G.+man, ef<.1 (SpRTilya ~(Y.<.) ~ MOS. DA
<br />Is American / ~,a, 79 'at.
<br />TH (Il na£in US.A., CIT12fNOf WHATCOUNTRY MARRIED, NEVER MARRIED,
<br />nIDOWED, DIVORCED fSp•<i/,)
<br />__ Nebraska ~4. U•S.A• Piarried
<br />(.~°_ _~
<br />SOCIAL SECURITY NUMBER USUAL OCCUPATION (Gi.p ifnd ai~.a•i dor
<br />(o/rrvriing lil•. Rr.n rl rpflrpol
<br />T2- 505-i$-7120 ~,aa. Farmer
<br />T~~ITY, TOWN OR LOCATION OF DEATH INSIDE CIS TT' lIM1T5TH4:
<br />).e Grand island „k, Iles j„d
<br />~RENDENCE-STATE jCOUNTY 'CITY. TOwN O
<br />,sn..~ebraska II„sb. Hall ~IS< Don:
<br />HER-FiAM-~-- FlR~-MIDDLE EA:
<br />_ ,,, Albert -- Alber
<br />WAS DECEASED EVER IN U 5 ARMED FORCES7 ~ INFORMANT-F
<br />(re E+1"n nn R ~•• one dor.. ef.«•.•1 ~
<br />~ IB No ~ IIRRhoda
<br />BURIAT: Crema+ien. Remomli DAik--~-,CEMETERY OR C
<br />~ :Jan. 6, 1983' i
<br />dnept an nvmb.,iaum„~+.-,.amp L..~
<br />Lut~Teran Memorial llo
<br />EOCATION 'STREET ANO NVM
<br />nhan ~ Isd Rt. 1
<br />January 3, 19$3
<br />DER I DAY ~ DATE OF BIRTN (MO.. Day, Y<.)
<br />f$. M
<br />a. Sept. 29, 1903
<br />AME Of SPOUSE (II.Hp, yirp maiden nomp)
<br />Rhoda Orman
<br />'RY ~COUNn OF DEATN ~ r
<br />„a Hall
<br />n eidre•, F HOSP OR INST. Inds<pr• DOA.
<br />p.1P0+I•.rffm•r R:w, I.paU•«f5P«d,1
<br />pita7~„p. Inpatient
<br />1( ~ INSIDE C17Y lIM1T3
<br />~(Sp ~ly Yef or NO)
<br />Box 132 its ~Io ,
<br />MIDID lam- UST
<br />ca -- - Tahnt-a
<br />f .-;,F.N„rp.. ru, n dy , W ,.T..,<.,~m.-,._m<,.,.~~ ......» ,,..... ~.. ~ .~_ . ... ... ........ _._._. _.., 68$01
<br />I _T ~< . ~_ ,.41 /1, ~+<'. i„Aofel-Butler-Geddes 1123 S:. 2nd_ Grand Zsland_ NE.
<br />`'. . ~ p:itE 51 NED (Ma., po,, Yr) -HOUR.OF DEATH _ zt ", PRONOUNCED DEA6 (PRONOUNCED DEAD(MOUr/
<br />`:81za5~ /'S"YY-3 za<. 7j~ I {~Fl~ .M '-'i`~''~.ad<,par.r<) 'a.ad. M
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<br />9NAME ANp ADDRESS OF CFRi1NER TPF<YSICIAN, CORONf CS IN IAN R COUNTY ALfORNEYf 1 F,p.4or rP r.,.,la t
<br />!aas Richard TI. FruehlinE M.Dn ~ 90$ N. Howard, Grand Isl.an~ 1dF. G$$O1
<br />.REGISTRAR - -~"~ ! DAIF4fICE1VED 6Y q6Y gEGliigAfl (Mp.. Doy, YrT
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<br />,"'+`2'/, iMME D1An RUSE (EEEER NlY ONF CAUSE RER /INE fOR Eai, Tb AND (<)) l nNml b.M.n .nr.F and d..M
<br />PART /~~-~ 1
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<br />WUZY A} tiN ti "J'"£iAtf d +N]V Rr_ Ar M•.•, Ipn•, rew<, larr•ry. - IOfATeON STRflt pt R IO N• CITY Ot TOWN ;}ATE
<br />lIpx,rn iN «NSI +<• M.Idip. •t iSpNdN
<br />E~„HM. iIDI. :3CH:___~. ___. __~_ ___~~._~__.__.
<br />WHEN TKIS GOPY CAF.RIES THE RAISED Sc].I. i,: THE iIEBRASRA
<br />STATE DE^ARTDSENT OF HEALTH, IT CERTII'IES THE ABOVE TO BE
<br />A TRUE COPY OP AN ORIGINAL RECORD OTr ia:ILli ld1`1'Ii '1'Itli STA'CI•:
<br />Pk:PARTHiENT Ot' HEALTiI, BURI•:AU OP VITA1. :rCA'P).S'I'1CS, Wlllt:li ,
<br />LS THE Li;GAI. DEPOSITORY FOK VITAL I.E%caxuS.
<br />F:RIiGUF C)k" VI'f.4L STATISTICS AND A:.SZS`I'Artit~Si'T?'r'r: i;i:<:`t5'L'RAI;
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