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<br />STATE OF NEBRASKA <br />COUNTY OF A.O~ <br />CITY OF HASTIl\lGS <br /> <br />OFFICE. OF <br /> <br /> <br />.19,-- <br /> <br />RECORD OF DEATH <br /> <br />THlSlS TO CERTIFY THAT THE. RECORDS IN THIS . <br />OFFICE PERTAINING. TO THE DEATH <br />Michael Ed:iIa1"4 Q'll;1Jm <br /> <br />of <br /> <br />Died on <br /> <br />Oetobel:' 26. 1961 <br />HaatiJ:lgs.liebruka <br />L. J. DeJ3aO"~ <br /> <br />Place of Death, <br /> <br />Name of Physican attending <br /> <br />Age Time of Death <br /> <br />72 <br /> <br />Place of Burial <br /> <br />pari:;v.\;elf c-ter,r <br /> <br />FiIDllral Ouector <br /> <br />11v:ings1;on, B\\tJ.ar, Volland <br /> <br />D€tllth Recoraea by local Registrar on, <br /> <br />Octobc' 30 <br /> <br />19~ <br /> <br />Oalecral HASTmGS, NEBRASKA. thiS ___12~----..,day of, October . 19~ <br />:'h ~r} l' 1 <br />1'/)'1 r ~ '1 <br />,.-L1 i '0 J ,,111./'1'71..1 } . (, - <br />1.. City C1eHt &rid . r <br /> <br />~ <br /> <br />L <br /> <br />..J <br /> <br />L <br />