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<br />STATE OF NEBRASKA-DEPARTMENT DF NEAITN
<br />BUREAU OF VITAL STATISTICS ~J~~ S) t t rJ 13,3 3,
<br />CERTIFICATE OF DEATH r ~ t
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<br />DE EDEN -NAME NISI M pptE 1A51 SE% I OATf Oi DEATH (Me.. Day, Yr.)
<br />Je+uuf ;GE}_- CJw.¢ch ~R(r,a.Ce ;~ I''n 70 1979
<br />IACE-(.,9-•Wb'Sp 61«E, Aw~ri<onjplGSN/DE`-_ENt 1.9~•14~I:o•. Me.i.on,~ GE-te.. a.nWu. r-_VND_ER-I TEAR UNDR DAYI~UATE Oi IIRI'NIMa., Ony. Y..)
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<br />luiu,te is F,nn-(,e.~'r. lae. .r7c5' ?ab is !~ Seu,t 19. (920
<br />CI wN0 STATE CN l1RTH (N nee :n U.511., ICNIIFN Ol wNAT COUNTRY MAfbED, NEVER AuRtlEO, i wtAf Qi SPOUSE (H,.IEe, g... midvn noww)
<br />~ y/ IW1pOWED, D,YORCED (Sper~ly)+N
<br />!_ ,e Csu~ ales-i Giir,.%n ' v 1. s. r._;~p rau2~z.-i ed i„ /2axa.ne Ee.Llumy
<br />SOCIµ SECURI1v NUMlER 'USUAL OCCUPATION (G:.v E:d o, rn.Y dons dvr;.q +p.I (tIND Of lUSINESS OR,NOUSTRY ;COUNTY Of pEATN
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<br />CITS', TOWNOI tOCAFiON Of DEAEN -1IN53DECiT'lIM1~NOSPtTA10l OTNfEINSTITU110N-~NOme (,Ewu..n«,M... uHOit of lHSi ~. a.. ODA.
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<br />RESIOENC[-STATE iCOVNTT Cltt-1JWN Ot tOCATtON iSLtf ET ANO NUMlE4 INSIDE<ftt tUAITS
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<br />A -NAME 1 MIpOI UST ;SbiNEI-MAIDEN NAME FIRS MIME ~-
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<br />r WAS DECEASED FYE! eH U. S. ~RMEO iORCESP ; IxEOtAUHi - uAME - vftwil0'+SHM - rM1l1uG AUpRESS i tti of t, D w. On OR LwH, sTSit tlrr
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<br />#HEN THIS COPY CARRIES THE RAISED s'EAL OF THE NEBRASKA
<br />STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE A$OVE TO BE
<br />A TRUB COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS .THE<LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />~n a d~ d~
<br />DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA Issued JaTluary 29, 1979
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