|
--.< ..
<br />TYt~aAl n6Nr IN ~ STATE CF NE•RASKA- UEDARTMEMT Of XEAiTN
<br />REpRUNENT rwa ~ EUREAU Of VITAL STATISTICS _
<br />sE€ndsr=panes - - GERTI~4CATE {3f DE14TH ~-=""~ ~Q~-
<br />MANUAL _ n, .
<br />acp ..,. DEC i NAME Ni25 ~ ~ l~A 7~--~15(~~ ~--- DA £ (MO.; DoP,' f~
<br />Sc ~~_--'- elerl f~4 Dale Spaulding .=Sale ~ MaY 3 , 1983
<br />~_ w a
<br />1D~(t. - ... .... I~eACE (r.q^. Y~ip,'g1a+F. A+nrri;w, QTE01W'EfEKENTIr.9~. 1•rl•nn, M..ken, a:n5d.y UiiOE~ 1 TE~t UNDEA i DAY DATE OF p1AEM (Me. Doy.T<.(
<br />l~ Indir,n rk J($WRlfy) Gr ~S;e { ~R (Y ) ~~ MOS. DAYE ~ NOURS. M4NS
<br />' C7fiite rjE.+ ~ November 14, 1923:
<br />%'IpCf ......... .. ....... CTIY AND 4tf AIRSN{H:rol +n U-5! CITII€NO<wNAi COUNTAT+MwkM ,NFYfk MARAt O, iNAME CSF SPOUSE (1(wdr qnr wo•drn nnnrj -
<br />,. w ~wr ED i D(Sor«yl
<br />n~vi~eaas Nebrask AfocapP.n U.S~A. ~ 0°~af~s'Le~ 1 Phyllis Price
<br />:._........._........._.. a R~-.-~-._IID )n
<br />• SOCIAi SECV9LTY NUMBER ON (G:•+Fnd o(wah dor.r dus:ng.wa RIND Of pUSINES50R INDUSTRY COUNTY Of pFATN
<br />-_........._ ....-... „r,..,F;nal:r.,...d.~..d, painter vase Painter ' Hall
<br />z.5(Yb-20-3$b7 X13,, Self eTE~oyed ~,a~ _ ,rb
<br />-CfTY, TOWNOR4GKAFION Di pEkTH -T4N514F CITY UM1TS iMOEPITALOk OTNFR tN51ITUT10N--Name rl(nn+In NfM<. ++l Etas.. ORtnrtT l~.JiE.r. oOA,
<br />- -.... .. _... Ira a IyY N _ 9i.r ,lre•/o.d ne+nbr.l ~Oapar:•e,/tw.• bn.+nv+naa•(Sn••d„-
<br />p c. 1
<br />i 1. Dena _han', :veb. asks ~,.<. Yes i „x_205 Svest tJ_alnut __ ~,,.~ - _
<br />-~' RESIAEN{E-STATE ~C.OVNTV rC TY. Tt)WN OA ICYATION' ST-I yEE?ANANC NUMAER INSIDE CITY t1M113
<br />~ 1(5pr yYer e<Nel -
<br />I 1
<br />"'""' Nebraska ~ "s< Doni han !ISd 20`> tdest Flalnut ,5, es
<br />., tso _ --~_._
<br />5xb flail ~-----~-
<br />. ....... AN ~-GJ~~Stf itR°+I -~M1 Y~----_`A5i MDTMFk-MAIDEN MAME EI'Ra( --- M1/T lA-iT~^
<br />~_.. -. - -_....... __ 3uldin -- Wessei
<br />- , Charles ~ -- S ~.u,_~._---Mara
<br />-1''---- ---~. _~ -
<br />.................. ... WAS D€CES.SED EVEk INUS Awf0 fC5RCf5> -~,INPORMANi-NAME-AEIATfONSH1P-MA541NG ADCRESS fStRflt OtlID NO TIp Ot TOW,tshh„$LFI
<br />. IY., ,n, e< ..M~cn ,,. R.,• .a. a.e ee.,. ,+ .,~~..+ G(SESSL
<br />-•--. -... T ~ ,a Ph llis S auldine Wife 2115 t:`. 4'alnut Doniphan, Ne.
<br />= EUiDR1, Grena,:aw, 4ema.aliSAY~ C(MfTERY CR CREM/.iORY~~ NAME ' 10GAt10N CITY OR LOwN STATE
<br />1 ~q, 3urial ~105'tay 6, 1983 ,g< Cedar View Ceretery z~ Doni han, iebraska
<br />4M£R-S1GNA1URf 6 I:CEN' ~ p ~ 1~ ~ L-, fINERAI ++OMf - f J ACDREsS SIREYE Oe e I o r+0 C+tT atptOWN SIAYt. LMr
<br />4
<br />1 ?pfel-Butler Geddes 1123 u.'. 2nd Craad Island, :7e.G
<br />---'- -- '-' ~- SAYE kiNED (MO Yr, iHOUP. 6f OEATN
<br />.. p ~.f n AT>e rMa Gar •.. - .
<br />. .. i -~ ~ .` .r n
<br />y , aTn ___ ~ _ <.
<br />i+OUA Of DEiiH F~ r ~PRONOUNC ED G'AO ~ '-60.pNOVN£EA DEAD!Ho~.) v
<br />• re a
<br />.... ~Y rCAT 5~F iGNED (Me.- Goy i
<br />-....- E ~1~3 . zaa to .r Mn esf ,r.i ' i33 1 : E75 n M
<br />d
<br />rta b•o b •w 5.,m,rwp,- a«+~ v¢:.ma +r n.• x.a o'o.• and L« a - O ~+.o
<br />. NAME AND A..^G t~ES~6c CEkS:E:fi lP fYSICtAn. CCXONE'k'S PHYS,C VAN OR iCVNtY A_TORNEY11irF• w x,: ~.: ~
<br />s PS. Clew?°c•, !tali t o int} ~h- r i l Iie~* . 1;s. ~ Locust (t. i. _. NF. -
<br />-, _ _.. __. .. - .._- ; xTF RFC fIYED 9Y #E : SLRAR r'MO Day T• !
<br />REE.ISTAAR - ---~-
<br />IMM.WAFE CAUSE ---- ~fNtE#l:•+'.Y lix, i.tuSi ifR r+N{ICR !., ~. b:. Ah~ r.. ~--~ -----~~~ - .e~-.a-i.*-.+ a ee e.a e•aw ~-~
<br />' r~ot•~JnarT• ccciusir,>n i~meditltz
<br />GUE F+. 3R A5 a COr.5E4~ r~+f.E Ci "^` •""•" °"•• a" °°
<br />-t II
<br />.............. DUE t0. OA A3 A CONSfiOU+N{f C? +..+,:,et e.e>,... u~.a+a..r awn.
<br />"• "--' ~ .•!A,S USE RereRtEO 10 M[oifA:
<br />... --.-.. PART CR[ S~CCHp+i Orv 3-<aW~wm.ur!bw..v 'o daae.. w..a:.•ro..e~ - FA~..l4 wA5,NftE O"~ • tl.wJwEt Ot CGtgNER
<br />11 vAr.C, rn tnEfASt]MON S rr•rr a.
<br />. -~ ~5....•IV i o• W)
<br />ia, No __ , i9
<br />_ y,8 lln _,-_-_-_~1 (~
<br />- . ogle w IN,un < w ~•eu+oE woR- --ofscnee Emw +wun Gec seen -
<br />.. - Acc+DfNT surcta. E,Awa e. uNCf Gw. ~. .
<br />...._._..._ .... of rPnrn•m INYfs*er,AVaw ra.•...n
<br />._..-_____.. _._ ! ~ M Tod _
<br />Mn. JDb.
<br />'~wtiu[ AA wMS -•---.....-.--~_- b`-___._._.-T-_- _... ____ ._ _eei of e r D Irs- - !
<br />5V ( a:A<frrr tNlui,-A:.a.... ta.. /+«•.lo~.•,. tCUt+Orr St "T, OR iOwH StAt
<br />'TSUS Tract NA. b 1Dr __ _°tef _ __-_-_-.__--- _~2~_ -..-.'-~_~.-_'._.'_~- -
<br />rR 03DJA-0DAt2ffi.
<br />
<br />
<br />
|