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STATF. OF NEBRASKA-DEPARTMENT OF HEALTH n ~f
<br />Bureau of Vigal SEaB.EieR ~ 84 ....~ 11 V e 1 ~jO ,
<br />CERTIFICATE OF DEATH,/i; ,., ., ,,,,,,,,,x„_,,,
<br />DECEASED=NAME ' t•f+ SER DATE OF DEATH ' .~
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<br />I. Erma. Irene' blay. T Female Dec. 14,
<br />1974
<br />RACE -nFG r,< x rxR AGF- u«R u«R O DATE OF RIRTN i..OHty a.r,
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<br />"Y COVNTY Of DEATH
<br /> s°~63 '~A' >,~~ f f
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<br />N , tDec. 18, 1910
<br />, Hall
<br />CITY: TOWN, O9 LCKATION Of DEATH
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<br />«~ HOSP,TAE OR OTHER R+SifiVTION-NAME ~ u xot w t~mre, e~.e stne~ .xo xux.n ,
<br />n': Grand Island - ,,•
<br />Yes ,~. 122 East 11th Street
<br />STATE-OF RIRTH In «oY w v..s..., «axe UTREN pE wHAT CCIUMRY MARRIED, NEVER MAgRiEO, iSURViV P,G SPOUSE to w r w.mF« xA«t,
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<br />,; Kansas <°,tx,.r,
<br />' U. S. A. W ED DrEOR D . fraur,
<br />Roy May
<br />,E 1DO~arr>.e`~ n
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<br />$OCIAF SECURITY NUMEER
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<br />505 70.9482 USVAI CKCUPATION teNe .~xR or vorR ew+t ouN«c .oft or RIND OP RUSMESS OR INDUSTRY
<br />«D
<br />BEikeiF« ., .F."tR t
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<br />Baking
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<br />RESIDENCE-STATE COVMY CITY, TOWN, OR LOCATION '« 'n rx.nf
<br />F<,'rr STREET AND NUMRER
<br />,w: Neb, I,u, Hall Yes«°
<br />„< Grand. Island. ~;,, ,,, 122 E. 11th St.
<br />s., Martin Richardson ~,,,, Ida Rose Gebhardt
<br />t1.WA5 DECEASED EVER IN U.S. ARMED FORCEST INFORMANT-NAME-REUlIONSHIP-MA1l,N0 ADDRESS ~ n t ++ r o *r o+' t •,
<br />°°`"°" no"°x"' ~ °°'"'°"' no °p1"°'"""°' Roy May-spouse-122 E. 11th, Grand Island, Ne. 68801
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<br />i ih- - - M~1f/
<br />LEItttNER-NAAfE'r•" o. Nr« r$1 NA}!~ ~~ - t DATE STONED :- '+ Rwt, eta
<br />~~.. C. Dean McGrath M. D . I rn f ~.{ L~t v. - cu ~ ~it'~ e f~~~ `~ t. ~=I~,, ~ ,1=(S -= /ci
<br />'. AtAIERVG ADDRESS-LERTR'tER
<br />`ia_ - 1~(04~W.RSecond Grand Ssland Ne. 6901
<br />_ gUR1AE, CREMATEC,ry. gEMOVwF CEMETERY OR CREMATORY--NAME tOCAiION em o. eoxx fi•H
<br />' ~srrci".
<br />:••: Buria.~ _;- _, _ TFR Westlawn Cemeter a< Grand Island Neb.
<br />DALE FUNE4Al HOME-NAME AND ADDRESS ~ . o •rt, i .'
<br />T«. Dec. ~ ~ 1 "w =,, Livings ton-Sondermann ~rt0 ~•W. «Koe " iY
<br />EM6A(W{('R-SICHA i~~~fc}}-RE R U/tCENSE NO. 192V REGISTRAR-SIGNA~URfE Att Re efvto Rr OCAf R 4f5t.wR ~/y ~//~
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<br />WAEN. fiyLSr'COPY.rC,AFRIES THE RAISED SEAL OF THE NEBRASKA
<br />STsATE ~~P;A.RTM~NT? OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A °Ti~*j}f$ tGOP,Y' 0~~ •AK ORIGINAL RECORD ON FILE WITH THE STATE
<br />DFiPART.~NT;;OF.>I~IEALTH, BUREAU OF VITAL STATISTICS, WHICH-
<br />' ZS~T'f}=°Lr~A~~II,EPOSITORY FOR VITAL RECORDS.
<br />DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA Issued DecelrlLer 30, 1974 _
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