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<br />H~T~ lJf "9IlU"_llP'lRTlltIIT OF HEALTH
<br />BUREAU 01' VITAL STATlSTlCS
<br />CERTIFICATE OF DEATH [J:.:.' j. '.1
<br />r- DK!DfWT -HAItI,f FIlS' "'tODl! \AST [SU 'I DAn Of Of A'" {Mo., 00'" 'Y#.)
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<br />I !,.. ,_'. _, Chesley Selby Baker I, Malel,April 21, 1984
<br />J ~C-t...., - , .~ ~~""'f~'=e-~!~!~~'i"~!':"""""~~~~"....II,t4f-'-~! UNDf:~ 1 'rE....' UNOfI , DAY IDAn,Of.IITK/Mo..Ow.Y,.)
<br />fed_."Jf.SP<<"rJ ~,"'H~jHCiI,J 'j , (Tn_) i MOS. : DAYS! MOtIfS: MiNil "'t
<br />. White .s. Amer1can . ... 56 i.... I.., I~pril 24, 192,
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<br />- t.w;I!Itfyi : lW1OOwto. DllJOKfDt5Pft'irt I . -
<br />.. Neligh, Nebraska I, U.S.A. /.0 Married ".Della R. lIal!;ensick
<br />socw SfCUIf11' NUMJfa ft1SUAl OC~lON fG.... a<-M 0/--' .... ftTill9 -.t ! l:iNOOf IWSJHfSS QlltfOUstIT IC_OUNn~. Ofl,"
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<br />,,506-38-9160 "10 AttQ,rney il3b ',... lIall
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<br />i lA. Grand Island, NebraskJ~~."~r~~orN.) l~:~r~~r~is Medical. Center ~ti~~~t-"
<br />~' 'Ull>.IMtf-5tAft !COUNTY 1Cl".,TOWNC>elOCATtON l$'Uft.NO~fl 1N$IOf:.. "~....,l.~$.
<br />_ I,. Nebraska I,... Hall I,,, Grand Island IS" 2505 W. ::-tJ~..HoI
<br />1 f.UHfI_MAMI n~ -.uo&r 1.A-Sf~f" J-MAJOEN '1 f
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<br />- Alva Gordon Baker' , . Gisene
<br />wAS- HC-IASIO MIIH t.tS, AbltO ,oact~-- ; ~NT ~ H.Mf''=.'tA.-noNsru,- MAIUNG AOOIt:"
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<br />100 It Yes-7i25- 5/2-14-47 WW n ::~.:::~wl:.r~~~~~.:; 2505 W. John Grand Island. Ne.611801
<br />r ~1JIlLU,c..~."""~~::ril 23. 1984 ;---....._? ~---_._'-- ..-..- i~ (i1Yf;a:tOWH stAn-
<br />100. r"! i"" Westlawn Memorial Park I20d Grand Island. . til!btaska
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<br />,,,Apfel-Butler-Geddes 1123 W. 2nd Grand Island. Ne.6&&Ol
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<br />B.D, Urbauer M.D, 2444 Faidlev Grand Island, Nebraska 68801
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<br />-" WIiEK.~ .;cOPY CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />STATE _AlmlEh'T OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A TRtlE.'con OF A.'l ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTJQf-OF REALTll, BUREAU OF VITAL STATISTICS, WHICH
<br />IS ~ DEPOSITORY FOR VITAL RECORDS,
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<br />JWMAIl!) ll. BECK
<br />ASSIST~~ DIRECTOR OF HLA~rH
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<br />I,sued May 2. 1984
<br />LINCOLN, NEBRASKA
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