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<br />
<br />83-001751
<br />
<br />STATE OF NEIIIASIlA-OEPAIITMENT OF HEALTH
<br />IUIlEAU OF ViTAl STATISTICS a 3 020 2 8
<br />CERTIFICATE OF DEATH 5,1'3>
<br />MIDOlt: LAST SEX DATE Of DEATH (MtI.. OOY. Yr.)
<br />
<br />
<br />DECEDENT - NAME
<br />
<br />I
<br />
<br />".Nebraska
<br />fA HEIt NAME
<br />
<br />I . Lawrence J.
<br />WAS DECEASED EVElIN U.$. ARJll,fD FORCES?
<br />(1.., "". O' _""kIll" fe.. g,... "'... ....d d..... ..I .....'~.l
<br />II. No
<br />aURJAl. C..emotion, ae-moyol OAT
<br />
<br />Krolikovski
<br />(STUn O"lt.f'_D NO., Cl"N 01 TOWN. STAff. Z"l
<br />
<br />
<br />19. L.J. otanski Son 4222 Arizona Grand Island He
<br />CEMETUY OR CREMATORY - NANoE lOCATION CITY-Ol TOWN STATE
<br />
<br />h 1 1 8 2lkWestlavn Memorial Park 20d Grand Island He
<br />~y y fUNERAL HOME NAME AND ADDRESS (SUUT oa II '.0_ NO.. CITY 01 TOWN, STArt:. 1;11"' Ne
<br />2~ivingston Sondermann F.H.,505 W.Koenig, Grand Isl~~d
<br />D....TE SIGNEO (Mo. Do" Yd HOUlOF DEATH
<br />
<br />;li
<br />];;t~ 240
<br />]~l: PRONOUNCED DEAD
<br />t:~ ~ (Mo., Day, Yr.'
<br />M ~i5" 2ok. 2.4
<br />~ 0 0 On MI_ b_..1 ...."'1...._ and/~ '"...."110"_. ,ft _, op,...on deolh ou"ned a'
<br />... V Ih. 11_ dat.....d pi..... olld du. to .... ~"w(I) ltoted
<br />
<br />2.4b.
<br />PRONOUNCED DEAD (Ho/,lr)
<br />
<br />No
<br />
<br />rl
<br />.u
<br />,j;
<br />J~
<br />':1
<br />:!
<br />
<br />25. Robert R. Koeioot, 1'1.
<br />
<br />IEGISTU.1 _ -, ,.
<br />
<br />.... ~/ ;,?J.lv:, " , ( -;"/d' ,_~ A r/,/(/
<br />260.tSi._"'''J~ '"'1...~~~ ~ - ..,_/ ~".-... '-'- . .- ~- .......
<br />27. IMMEDIATE CA E~"{EIt ONLY ONE CAUSE PU UNE FOlfa). fbJ. AUD (dJ
<br />'AIT ~. I
<br />
<br />:., . '"1..:fYl. ,C--', "'lI.t-/Lf.t,G--,1 Vt?YU--A
<br />
<br />DUE lO, 00 A}:l!:~:NCEI' ~
<br />
<br />{lo' /- L-r,' f..-.( '7. ,( _>. I..-nr--
<br />DUE TO. 01 AS A .C;ONSlEQUfNCf Of, 0#........
<br />
<br />lie.
<br />
<br />
<br />/i (L-.-z.~:'-~? ~
<br />
<br />DATE RE.CEIVED BY REGISTRAR (Mo.. Ooy. Yr.) .-
<br />26bV.J;;C-<2-A ,1/ /yJ- 3
<br />ffl~_1/7Jc.-
<br />
<br />I....roa( b...... Oft.. ond d_tfl
<br />
<br />'00.
<br />IH,lUt't"-,u WOU
<br />fS,..,afyT.....,Hol
<br />
<br />STllIT Oft l f_D_ No
<br />
<br />CITY Of TOWN STAlE
<br />
<br />,..,
<br />
<br />-~~~';;.\t'\""
<br />WHENta..t'4,~;~~RRIES THE RAISED SEAL OF THE NEBRASKA
<br />STAIJ!l:..j)~P'ART~tElii'..,'OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A TR;~1Qo.!'YQ.F':~N";~ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPA~1~~~T)qF;H~~~H, BUREAU OF VITAL STATISTICS, WHICH
<br />IS :'Rl.!:!S.<LEGAL DE~S.uORY FOR VITAL RECORDS. '
<br />
<br />'-~~~~~~~;",.--~~~~~
<br />
<br />DIRECT&R'~~~~STICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN;': c-:,c- . Issued April 11, 1983
<br />
<br />
<br />Lot Six (6) in Block Eleven (11), in Packer and Barr's
<br />Addition to the City of Grand Island, Hall County,
<br />Nebraska
<br />
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