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80001064
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Last modified
1/13/2010 1:40:51 PM
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1/13/2010 1:40:46 PM
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80001064
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<br />- - STATE OF WEBRASNA-DEPARTMENT Of HEALTH <br />BUREAU Of YlTAL STATISTICS <br />$~-~ '~~.~s4 CERTIFICATE OF DEAT~r <br />FIRST MIP~IE 1A5-- iEX <br />DECEDEN <br />Sessie Gladg_s. Anderson aFema7.e <br />1 DESCENT (e y.. f:elioaM -TnGf-+n.+e,.+°d.r UNDER 1 YEI <br />RACf (a.9.• WAda 81act. Mn ' an ORFG NI etc.I (SPK,F>1 / i (Yn.) MOS W+ <br />Ind.an a°) (Sp.c:F>1 GT 4 6a 6b <br />«hite i e rican <br />! GITI2EN OF WNAT COJNTRY MARRIED NEYERMA0.RIED. <br />CtiY AND STATE OF 61RTN {N aet ~. U 5 A. wtDOWEO MMORCED (ipecif>F <br />~ .na ceaarr>f ~~ei~• Ne 19 B.SA ~10 ~' cST_~18Ct <br />y mo.5 i ~ X+ND OF eUSINE53 O'. <br />SOtlAI SECURITY NUMBER IUSUAE OCCUPAitON iG..e tend of work done du.~n + ' <br />ot.o.Gtny l,k, e•.n if ral..<d) ~ _ + ` ~OtM <br />a+ Na! <br />=+~e.__ <br />TOwN C <br />No) <br />fir. _.. ~..,j ~ar+ ____Xr1[l~rs~n '_. ~EiE7~~' <br />Ta - _ <br />-~ y/AS pECEASED E'Y'ER IN U i. AR+nED FORCEST .NrOAW-rIT-NAME- RFiATICN: S.~+)P- MATTING ADDRESS 1S1Ntl Oe E i D Nt?O...oOT Oe T w <br />- ~, ..a anR. ,,. »,... } l SASHti'Ti.~_°++bnC 191,ariC~Ti~@1 <br />TR --~ ~ •,a•.,•,,;,;• "•. ~.• !I9 _Ggr9l Anil ~'SLT1:~115~tiL'$-`~-~-s~A~- nY OR TOwN iTATt <br />SCKATION <br />GFMfIEA r OR CREMATORY -NAME <br />~841RSAt CREYATtON. RFMOVAi DATE , , ;'Od ~ xi--.~___- <br />} ~2m rj'Z'~~'~ Id 5'.•12.7rF.'.-L..i4~.--_r8.~,__ ` lOYb301 <br />DEb. ~ TTl , FyNERA NOME N D ADD0.ES3 STtffT d l i L NO. CST Ot TOWN STA.E Z <br />EraA1MER $lGNATURE a trcENyl Nu 18b`)' . t GTL1T`a 1S} i1Tlt> / - <br />f y~;L~ y ~p j ~j woe?77. ta'> i:8. <br />1t ~~-~'Ti~~ ~7 ~'E'i~--f- „~,'2~,. A.,a'1. o.~a ,`. w,~..~p e-~C ~.=.~...°aov~...w.n.. wea...b.. w.A.°.a.~.~.a'P ... a»...: ,.,.a« <br />TY ~3]c :Sp>..+wTrwri 'HOUR OF DFAIt~'-~-~ _s~ if)Al€-51~.1VFD 1~. Y~.~ <br />-" ; DaIE i1GNED t«w.. DoY. r. > ! _ - _ _ M <br />1-, ~ 1 ~^ ~ ~~ - `- `~ ~. __ - 'a6 .'- 'PRONOUN[ED DEAD iNa.r) <br />i r.J ~' ~~ ~ ~'= 1 1 ~23?__ - -' , ~: iRONOUNCFO DEAD I <br />ARONGUN~FI)DFADftla-+r <br />I:i_ N <br />3~? - asK-N~Hn TTOrtNErlip P <br />-NTrt.TOO+(•noRFS n cE:z+F+ER tPNYSG°.N. Goeor.Frs o98J1 <br />~1s'.=,rT-~.7.110:,> "r'.. ~. ? SUn :: a . 41e Ltl~'Z1, G:' =*'•fl _5 _axla>~~ atcerve~aTAAR (Ma . Dn_!. Yr 7 <br />.~~7 yam!#TE CAti3E TENTH DN: - CALRI~' riE FDR'e: /bt. ANDi ), <br />W1 <br />iFIiE >O. OR aS A CM2SEOVfNLf OF <br />1 ______ __._.- ,.,.o~ E <br />~ _ <br />DIIF TO. OR Ai a CONi£OUFNCE OF. <br />_- £ ~S TNtRE. AyTOaYe ~ w~S ~~.. xDE w'~... <br />~ ~_-_- - -t wTNf aaSi>r0>•2.f~a ;5......a *+. a: '..~~ ~FrtamE>MC <br />~~ D1NFa SwNNtiAKI CDNIVTDNA-La.onm~.srvx,n...p v a e uu~,T >< ~wt+i a:« . ~~ <br />=" •- + y . _ \. '• . ~~ ~,xO:i Di w ; ZIFiCb t wDw tiJW. DCGU>aED <br />KCOEM. ii1K'41E. wD+M`.rn+..ViDF1"Ylf W IraluE+ £w .r ' <br />DR ap.pNL IN tS11:.~TWN ~: z.~. +r. ~ _.___.-___ <br />- ~ _300 __3~ .. M ~ 30d-_-_._ -.._- .._ __ ..TY STAB <br />3BO --- inaw ~ f ~cJt'a: KIN Si>£fI OA>T: ~ <br />. TROT _._~$_.__. ___. _-_- _..}. <br />~g~„rp pgl~~'~pPY CARRi£S THE RAISED SEAL CP THE N£BRASkA <br />S~~r~i ~}524£RT flF }1EALTH, IT CERTIrIES THE AB04E TQ B <br />dit SflL,18''CQFY 'UP AN ORZl;INAL RECT'3R'a3 O'rT FILE Is'ITH THE STAT£ <br />B$P~AY?MEliT' flP HEALTH, BURE~t' Or 1ITAL STATISTICS, WHICN~ <br />~~ +~gE?^~„~6A3,, D£PflSITflRY $t~k VITAL RECORDS . R ci <br />y .£ ~~ SrSyA~' STATE REGISTRAR <br />DtBF.C1'flROF VITAL STATIST may 25, 14i8 q`~ <br />LI1~i3LN, N£~ _ Ste. <br />1....~ <br /> <br />
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