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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRTJ>y~~aP*Y~ ~ ,
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMEN~''~O~JH>T~I" ,
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOS:ZT:QR~'~ORr.~~'••~~,,
<br />VITAL RECORDS. ~ ~"~ ^~'
<br />r~ ~ .~ :F
<br />DATE OF ISSUANCE ~~. ` ~^ :~•, '
<br />DEC 31 }g85 2 0 0 9 0 7 8 0$ STANLEY S. coa~~;yy~-~. ~c~~i~: ~~'
<br />' .M.. ,.. ~A y •
<br />LINCOLN, NEBRASKA BUREAU OF VITAL''~S~d~~~~fiT,~,~ , ~~
<br />STATE OF NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATHS ~~~~,
<br />DECEDENT-NAM 1 MI lA T EX A A H (Mo., pay, Yr.)
<br />,. Leon Cords s. Male December 26 1985_
<br />RA[E-(e.q., Wk:M, !lack, Amerkan ORIGIN/pE5[ENT (e.q., balian, Me+Iican, AOE-tar RiM.da, UNDER 1 YEAR UNDER 1 PAY PATE OF BIRTH (Mo., Doy, Yr.)
<br />i
<br />Indian, etr.) (Specify) Geregn, e1c.) (Sprci(y) f1'n.) MOS. DAYS HOURS ~ MINS.
<br />January 7, 1924
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<br />61 ~
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<br />~FY AND STATE OF RIRTN (N no/ .n U.S.A., CITIZEN OF WHAT CCIUNTRY MARRIED, NEVER MARRIED, NAME OF SPOUS! (N a•:h, qiw moiden name)
<br />noels csuehy/ WIpOWED, DIVORCEp(Specify)
<br />Nancy A. VanWey
<br />Married ,,
<br />U.S.A. ,D
<br />Nebraska ,
<br />Ainsworth
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<br />SOCIAL SECURITY NUMBER USUAL bCCU-ATION (Giw 4ind e{rerk done dorinq morr KINp Clf BUSINESS OR INpUSTRY COUNTY Clf DEATH
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<br />CITY, TOWN OR LOCATION OF pEATN INSIDE CITY LIMITS NOS-ITA~ OR OTHER INSTITUTION -Name (II ner in airher, IF NOSF. OR INST. Ind+ean DOA,
<br />Ovrperwnr/Eenrr. Rw , Inperi.nr f SP«%ry)
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<br />RESIDENCE -STATE COUNTY CITY, TOWN OR LOCATION STREET AND NUMBER INSIDE CITY LIMITS
<br />Tsb. Ha11 "'
<br />Isa.Nebxaska ,k. Grand Island ,7d, Rt. 3 Box 5 r~~y~'}OprNa)
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<br />fATNER-NAME ffRST MIDDLE LA T TMER-MAIDEN HAM IRST MIDDL LA
<br />Martin Cords
<br />Ott Grace --- Metcalf
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<br />WAS DECEASED EVER IN U.S. ARMED FORCE54 INFORMANT-NAME-RELATIONSHIP-MAILING ADDRESS {STREET w R.F.D. No.. CITY oR TOWN, STATE, Zv)
<br />(Y«, no. « vnM) (N ,r. pew ..a. and Beret el ra.:cel
<br />No
<br />`' NE.68801
<br />Cords-Wife-Rt. 3 Box 5-Grand Island'
<br />Nancy A
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<br />~ BURIAL, Cnnwfion, Removal OAT CEMETERY OR CREMATORY-NAME LOCATION CITY OR TOWN 5TATE
<br />Dec. 30, 1985
<br />~,. Burial zob.
<br />ppc- Shelton Cemetery
<br />~. Shelton, Nebraska
<br />EM AIME -51GNATURE i LICENSE NO. ~ / ~ ~J FUNERAL NOME -NAME AND ADDRESS 1STEEET OR E.F.D. NO.. UFY 011 TOWN, STATE, II-1
<br />=zl~~/I~~~ ~~ z~pfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.68801
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<br />ss. B.D. Urbauer M.D. 2444 Faidley, Grand Island, NE. 68801
<br />REGISTRAR DATE RECEIVE RY RE 1 TRAR ((~M~epp.CPay, Yr.)
<br />Tba.(Signo/vn/~ Ybb. O~C ~ 1J05
<br />Y7. IMMEDIATE CAUSE ....T. (ENiER~NIY ONE CAUSE P R 1,fNE FOR (a), /b-, AND (c)) Inhrwl berwe.n onrer and deaM
<br />PART - ;
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<br />DUE A C SEGUE E OF: , -Irn..InT~w.rn~onNe end daaM
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<br />DUE TO, OR AS A CONSEQUENCE Oi: .. ~ ~ { InMrvel between en.N and deerM
<br />PART
<br />11
<br />ACCIDENT, SWCIDE, HOMICIDE, UNDET., PAT! OF INJURY
<br />OR FENpMG INVESTIGATION. (Sp«:ryl
<br />7Da. 7Ob.
<br />1NlURY AT WOpI FIACE OF 1NJUEY- Ar Aewe,
<br />(tpeeiry r« M N.J eHie. -r:Ialhq, Ne. (spK;ry)
<br />- 7h. aDl.
<br />wNwq M dwM bar nN related -ART 111. II FEA1All, WAS TMER! A AuiOFST
<br />/REGNANCY IN TN! FAST 7 MONTNSf (Sp.eiry T er Ne,
<br />Yet ^ Ne ~ --~ ...7R, r" ~q' _
<br />(Me., Der, Tr.l HOUR OF INIUR'T DESC RIR! 110W INJURY OCCURRED
<br />170c M 170d. _ _
<br />weer, feet..,, l0(ATIDN STREET OR R.F, D. Ne.
<br />sp«:ry r.. a Ha) a C-"°: _
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<br />CITY OR ipWN STAiE
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