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<br />~,j~°p STATE OF NE9RA5RA-0E9ARTM~,'NT OF HEALTH
<br />LV~YJ~~ ®UREAU OF YITAL 5TAT15TIC5
<br />?9- siV CERTIFICATE OF DEATH,=~_ ,,,
<br />
<br />DECEDENT-NAME GIRST MIDDIE !AST SE% GATE OF DEATH (M9., Doy, Yr.j
<br />Pearl Irene Olen ,Female ,- ~tt~;ast 20, 1979
<br />MCE-(.-8-• Wbile, BiuS, Amerixon dIIGIN( DESCEIJT (e.g., Ieoli9n, Menkon. AGE-brr RinMCT VNDER t YEAR UNDER 1 DAY DATE OF dfRTH IMO.. Doy, Yr.)
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<br />te s, American t,:U ,.. 68 66. 4. ~,. Feb. 17, 1911
<br />CITY AND STATE Of RIRTH (N ner in U.S.A., CIT12EN OF WHAT COUNTRY MARRIED, NFYER MARRIED. ,NAME OF SPOUSE lI(...h, giw moiden name)
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<br />R_ ~ 3iit~e, Ne.
<br />v. IISA I WIDOWED DIVORCED ISpxily)
<br />D. k(ic~owed ,,,
<br />SOCIAI SECURITY NUMREq USUAL OCC UPATION (Gi+e Wnd of w9ri don. daring men RIND OF BUSINESS OR INDUSTRY COUNTY Of DEATN
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<br />12.50u-~9-7903 of worYin9 Ii
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<br />ntenance Wcrker ,'+li~` ,76. Banici:lg
<br />,,,. Hall
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<br />u.theran l~lemorial.IosTlital IAe. In tient
<br />RESIDENCE-STATE COUNTY CITY, TOWN OR LOCATION STREET AND NVMBER INSIDE CITY tiMITS
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<br />15a. Nebraska ,sb. Hall
<br />ISc. Grand Island
<br />Isd. 10 E. 1 th Ste f5pe<i( ea er No)
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<br />A -NAME 1 T MIDDLE LAST MOTHER-MAIDEN NAMF. IRST MI t lA
<br />s, r`Ylward Trieahan ,. Tr FalT~er
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<br />WAS DECEASED EVER IN U.S. ARMED FORCES, _
<br />INFORMANT-NAME-REIA7IJNSNII-MATTING ADDRESS (STREET OR Rr.gdq.. U]l'~pR,jpy'w SPATE SIM
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<br />,R. Nc , ~,g. 2•' s Patrick Gil roy-nsTy~}~~
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<br />,~ ~aou (MO.. Day, Yr~) cV/LO/77
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<br />COUNTY ATTpgNEY! (type or print)
<br />~~ ^ _
<br />7frAµE WAS tNEeE A AUIOESY wAS CAFE
<br />KY IN THE MSt S MONTMSI ISpx~ly Yx x Net I EEAAYNft 1
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<br />-- $~ ~R `~~ BST,-~F- HEALTH, IT C€€tTIFIES THE AHOVE TO BP
<br />1~ ~C~ELSG ~~'e'rKN ORIGINAL RECORD ON FILE WITH THE STATE
<br />?~ E .1t~~EALTH, BUREAU OF VITAL STATISTICS. WHICH
<br />I'&`,~ ,~Q~DEPOSZTORY FOR VITAL RECORDS.
<br />~~ ,~' <. ,',~ g E
<br />DIRECTOR OF VITAL-STATISTICS AND ASSISTANT STATH REGISTRAR
<br />LINCOLN, NEBRASKA Issued September 7, 1974
<br />MEMORANDUM
<br />T0: Hall County Register of Deeds
<br />FP.OM: Earl D. Ahlschwecie, Attorney
<br />DATE: September I0, 1979
<br />RE: Pearl Ogden's Death Certificate
<br />~--- 1 Please File-the Death Certificate of Pearl Ogden
<br />against the Rear Es Gate legally described as:
<br />Lot Six (6), Bloek Seven (7) in George Loan's
<br />Subdivision, an Addition to the City of
<br />Grand Zsland, Hall County, Nebraska.
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<br />
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