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<br />STATE ~ NEBRASKA-DEPARTMENT OF NEAITN
<br />6UREAU Oi YITAL STATISTICS ~~'.~~ ~ ~~1
<br />CERTIFICATE Of DEATH ~ 3
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<br />DECEDE ~ NAM FIRST MIDOIE UST I SEK DATE OF DEATN IM° , D°Y. it )
<br />John Edson Coding .Hale LOct. 3 1982
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<br />CI AND ATE OT RIRM (N roi rn U S a , G11LEN OF WNAi COUNTRTIMARRIED. NEVER MARRIED, 1 NAME OF SPOUSE (tl.d,, yrro m0.den n°«e)
<br />WIDO D. DIVOT O(SVe<dyl
<br />m`~su'~ine, Nebraska ~g U.S.A. .,D ~arrie~ (,I Ruth Kaufman
<br />SO[IAE SECURitt NUMBER USUAS OCCUPATION (G,.e Send el.orE dewE de.rnq meN KIND OF RUSiNE55 0¢ INDUSTRY COUNM1 OF DEATN
<br />712-03-5618 °/~°~'esaurarit`~perator~ ~ Restaurant ~ Nall
<br />17. 170. I]b lao
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<br />WAS DECEASED FVH iN V.S. ARMED iORCfSi INFORMANT ~-NAMf -REUTN]NSNIP -MAILING ADDRESS ISTEEET d K E D NO.. Glrt W TOwri, Stilil. TIN
<br />fu."n~,o.w5lllx,"'°,n _e. enddnn,nl,......1 ,, Ruth Coding-Wife-1504 W. John-Grand Island,. NE.68801
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<br />7 ~7]Apfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.
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<br />NAME AND ADDRESS OF CERiIf IER (PNYSICIAN, CORONER'S PNYSICIAN OR COUNT'/ ATTORNEY( (Type e. PrinH
<br />7s J. J. Cannella M. D. 729 N. Custer, Grand Island, NE. 68801
<br />REGISTRAR -~- ~ DATE RECEIVED gY REr.15tRAR (MO.. Day, Yr.)
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<br />ACCIDlNI. SWCIDE. NOMICIOE. UNDft. DALE M INEUtT (AN., Dey, Yr 1 NODE OI IWUET DESCEIRE Now IWUEY OCCUtllD
<br />a PENDING INVlsiIGAIWN (sP«.i,l
<br />70.. - ]Ob. 70T. M' ]Ild.
<br />INIUtY AT WCMIt fuC! 0E IN1VfT- Ar bme, larm, x.ror, loom. VOCATION - STREET Ot E F D Ne. Clrt OE TOWN STALE
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<br />WH$N ~=T2i,`P$ $,t Y` CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />S,T1~x~C"`.D~P"!~t'~~NT OF HEALTH, ZT CERTIFIES THE A$OVE TO BE
<br />A ;T~E: COP~f' Q~,'I~N ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEE2AR~E1~:%O.g ~~tALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS~,~$ ~ ~lKj. IIB~.OSITORY FOR VITAL RECORDS.
<br />DIREC~OR~jQF~'$TATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, NBBRASKA Issued October 18, 1982
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