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<br />SFATE.:QFNEERASKA-OEPAFTMENTOFNEALTN
<br />t~~~~_. Ck! ~~..~py, EUNEAUOF.VkTAISTAYBSTICS 7 Q. 3.~.~ 1} 2.
<br />G7 i(~ ( GERTI~i£ATE Qf DEATH
<br />DECEDENt-NAME ilRST MIDDIE lwSi. ' SE1. ~ DATE OF DEATN (MO.. Doy. Yr:l
<br />~t ~ 8ogd H2suy De~schv I~l~rfe ~3Novem~uc 3, 1979 ~
<br />RACE-j•.g., w}e;Ee, 6Lad,wienuonsq,E3}pLfDESLFNTf•-q., Ieon. M•+:can. ALE-Im. R~.rmoy VNpER 1 YEART UNOER.I DlY DATE OF BIRTN fMe., Der. Y. ,
<br />f Sp«.EY) G•rmon,• }rS i(y ~(Trt) i M05: DAYS MOURS~ M}N5 i p
<br />~~ f s ~inyt`~t:~rn i M,. 7 Q' I~ ~ ~ ~,Des.em}b eat 21, 19 01,.
<br />CIT'AND SIATEOi B}RTN (If woe ~n U5A:;.. 7t7Ii1ZENOF Y1NAi.000NTRI'MARRIED:.NE'vERMARRifD 'NAME4F 5POUSEfif t/., g:v aid•n name)
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<br />'mwyfavmr ~~l iV}~/LLWKQ ~g, unS sf1• f)0. FIC~I~~QQ 11 ~.UQ~n Jo.~d~~
<br />SOC IIi.LL.•~SJECNVJ#ClTY~NVMBER 'U54AL QCCU.AT}OY(G ~1 daE.orEd 'rv:wg mot iRiNOOcfBVSENE55 QR ENOVSTRY :COUNTY OF DEATH
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<br />C}T'f. lY]wN ORifKATiON Ol GEATN ~FNSLOE CLTY IEMETS NOSHTAI OROTNE[iN541TU1}ON-Name ~Ir er :n •,M•r ~I IiOSf:.OR HST ' e+a DDA,
<br />;.~'~and latand Nebxaaka. 's.,.r;~~erxe} stg,..r~r;~~1°i~ati' ~temat.~af Hob .~ta.~ ~~ "Yn city'.°ent ,:n-d,,
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<br />RESIDEfKE-STATE 'COUNTY +CITY.TOwN OR IOCATLON 'STREET AND NUMBER INSIDFCITY tE.M1TS
<br />u~%P,~RQ81t4 ?TSe. Ha,Lt ;s Gland Ib,fatcd }se 623'N. t:Jh.ite ;,s;"'~~S""®'
<br />A -Nyd 5 MIDDif tl.ST M04NfR-MAIDEN NAME FIRST MIDDL L.~S'(-.
<br />Geox W. Desch kid.~e F. Fa~ckeR
<br />. wASDKFLSED.EVfR FN U. S.ARJAfD lOKEST ':INFOIMANT-xAMf. _. gELAtttDNSN1P--.M,iLING ADDRESS :sifffl Dq•+.o. 'i+O-. C~h OR TOwN:STrrE. ii11
<br />;No Sg E K Deach Gl< a b23 N, u+h.ite Grand IsYand, Ner b880I`
<br />BVRLA,L,G .aziDAF ~fEMEtERYOR4REAtA}ORY-NgMF ;LOCATION CITY6RTOWN 54ATE
<br />i ~Wt<etf ,~ma iDS 11-6-.1979 ';a G~tand 3rLand Ceme.t¢hyvy,~ C,Rdnd Island, Nebraska
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<br />WHE2: T.~t~$ G~"FY~ Ci,ARIES THE RAZ:SED SEAL OF THE NEBRASKA
<br />STATE -d1,~PARTN,EhT OF HEALTH, IT GERfiZFIES THE ,1BOVE T©? BE
<br />A T2tUE=Cl7FY Uc 9N ORZGIZrAL REflURU UN FILE WIT$ THE STATE
<br />DEYA€ZH£NT LfF HEALTfi, EUR~AU OF VZTAL SSATISTICS, WHICH
<br />IS tElxe".L"EG.LL DEPCY~rTURY FUR' lTTTAL RECURi3S,
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<br />DTRECTQR OF-NITAi:. STATISTICS A[ZES 'ASSISTANT SfiE,TE REGISTRAR
<br />LZ2:CflLti, SESF~iSfif= issued Match ~9, t482'
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