|
-Lot 3, Block 18, Schicnmers Addition to fhe City of Grand Island, fisll County,
<br />~,.t - s7ATt- ~Iff~NR~SK~AVST~M. sits ~~ P~iebrasl~a
<br />- -a..wnFUCT~oM Df~AME ftRST wpxE t15T---- ~5E3 (DATE [Ab., 0^E. Ya,I _ -.
<br />n rs+FU.F. , - 1 .1 -:.
<br />' AtARiE t!IiLHELlUINA KfLLER `, Ferrate 1, !Iau 31. 1979
<br />:,~.. 4CF <Rl-. vn.y. awrk A.•.. n~tYKHN OFSCENTfr R.. Helion, M.as°n wGE-rs i..;a~, ~_ai0Et1 YEAR U-~iDATf OE /ffMfMo., Wy. n.) -
<br />m1w. IFS «,yi 'GArs^ .+e YfSR«;yt /Y.. MOB' GAYS I NOURS . wN5'
<br />>r. F;` tE~ie~e _13 AmT<eun ,~-_?3 _ i~ ;e.__ ' ~, OeC. 14. 19(15
<br />~~.. --{RY AND STA~Of 61lTM lM iwU-S.w., (CITIZEN Of WHAT COUNTH ~~~MAlR1E0, NFt'ERMARItED -'NAME Of 310USf(tl wla, gr.a..eibnner/ -
<br />,: •e;•• cer~~A'Ft r 1 - WIDO ED. DNOKED; Sp...Fyt - - -
<br />:_. _- . , t1~m~(.~LDfi Co I , NE 14 USA. ~„ tAcwt.~ed 1, Wrvuen V. Ke.f.C2X
<br />_~T _._
<br />~+~: SOCIaISKURITY NUMRFR ~USUAIOCCUtaTIpN IG~.. F(nd of.o.F don.d .~.4 A.r '-'-[INDOf lU5tME55 pi~INDUSTRY COUNTY Or DEATk _
<br />- of re.E~ I if.an(
<br />-- ~ „ 506-22-5147 {,,, ~° ~Houaewc~e ~ ,h Dame~,Lcc_ ~,., HaCI
<br />r-r-----, __-- ----_. ~- _
<br />CITY, )OWN Ot[a ATfON OF DtfSN 1N5lDE GRY UMITS'k65NTAt OR O.MEfI STITUTION-NO..•tlt ner ...M•r~~NOY WMSE I~.f pW, -
<br />~Y - f5a«ey1 - P..•.na•r dnunb•rl 0.tinsrlF~r b,Weaw(Fpsiyi
<br />,a,_ Ghaxd lgfand ___ _~ Yea ~., Lu.~Eexan !deman~lz.t_ Hodp.itcf 1iti Tn "end
<br />,-- ~ - 1E51DENCE~ ST TF - 'COUNTY ,CITY. TO NOR LOCAOON ~St1EET ANO NUMIEE 1N510ECM EMYf!
<br />l3 Yva!rF
<br />'- - Y, Neolte,bLcc ` sh Ha.CC ~~><. Gtand I/l2and IISd 4 J2 (U,. 16th _ .5.. yi
<br />- - , rA R-- NAME -- fli'~T -` wpdE (AST - MOiMER - w (DEN NAME NRSi w~~-"-,
<br />..~ '
<br />~ , . Rcchcud - Kuel~n2a Rzea_- ---_ 8ae,aePma~
<br />WAS D[(f ASFD FYER V.S RMED FORCES INFOtMA - AMf - F O 5 !E MA GADDRE35 tErETR M a o .M-CITY OR 'ZIN - AC1
<br />I~ eok..! r..... ~1a6 ~r -
<br />f , 4[ ~4~J2 WcuReft V Ke,CPea_Htwbaxd-412 Uj_,_-16.th-G~Eand Ia.Cand- NF
<br />_~~-- -' , RuRIAEC•.•+a mai!UA ~-~ ~ ,= JCtMET[tY fiR CR MATOt EiAM[--- ~IOCATION CIT Ot TOWN STATE-
<br />4
<br />- ,D, g~.~ zob 1974 ~a Grtand _IhPand CCmete2y, _ ~ Hand (eland NE.
<br />EMM SIGN (URF t IiCF SF NO af' _ ~/y tU FR OM[ AME D 4DORf5S rttt oR a! a NO CNe OR (9WN ST f - 1
<br />-- ,, ,.•»..,t~.-.~- rl ,/~}wz~~?ye~.Bu.tFvt Cedd¢a 1t13_~Ua Yak G~~Z~Tlintl~ NE. a88Dt
<br />~- ---.- - - ~ q d b.
<br />K, • '2b ,GR d .~- i Srf_-../~L~--~ ~s 7 ,:,,.wr.,. ,N ,,,„-
<br />; S DATE SIGNED 7Ab -Dar +~ NOUR OE DE TH DtTE,Sf~HtB jM'o'JaT Y. 2TUi~~bEAlii"~
<br />'ISh_ i]J. zz M
<br />i ~ ~~ ~ ~ ~ ~ ~/~ 'r0 vROaiOUnCED DEAD - ~IONOUNCE
<br />' DALE Of OEATN TAb. D F.. Y•.) oOV OOEAO (Nwrl
<br />_ __ __- _L._ - __
<br />~ NAME AND ADDRESS Or { 4TIi1E! (EHY$ICIAN, COIONEf 5 VHYSICIAN OR COUNTY A'o , Y '
<br />_ ~~~ L E. 1me,6 !.1.D. ~~0 U1. D<vi.aion Grt,znd,-~fcVid~--ti~€_~-_ 6~.&.Qi
<br />$ '-tEGISiIM ~--~~-_ ~ -~ -~- ~-~ ~ ~ l-~- pATE RECEI fD dY REGISTRAR (Mo OaY. Yr.I ppI
<br />__. -. ~ Te• ,S.a„•r...,- _ - !man g~;
<br />_ _ _ _-. ___ _ .. - .____ _ ... - _____ 't~
<br />E) ~I) IwVAED1ATE CAUSE (ENTER ONLY OMF CAUSE vft 11NE fC1M (~I !b! ANp .r ~l I.w~•1 aw..w. •..r.N aw:.
<br />?:
<br />~ ~ r,.RT n ry~,.~p ~ ~v ~d §i
<br />-- ~i0 OR~w3 A CONSEp Uf NCF OT ~ -.I .wwr rnw •N d•.w
<br />. _ ~ lel _ _ ____ a
<br />DUE TO. 00 A$ A [pHSEOUEMCE O~ I^'•^n' aa'.•« •n^ ^~a <aaw
<br />w---.. ..-_ I.I _
<br />` fAIE OIn~rGNNKAM COnprIMJnS.._GH+ ....w.e.r..a r a« .. . - .. 1
<br />b-' ... ei1 d.H"tea ..FC»..r~.l« .e .sll,.D p, a tie ~fiRRE~Eir: wprcu `
<br />t IxAwH c f
<br />e f H M1
<br />s 'iw•.lr Ysr o. i+a1
<br />~E- K -M - -SVK at /HYCW! DF _P•lE.Of aU r,N• a+r _»cu~~ee Iw.;a.- .-_ Otst. wRl ...:w .v C~«Ea ~_ -.______~
<br />._ ... __ _ oa nxgNC ~n IIr. TIDN rs•..m ..,.
<br />s _ .- - .- .. - _ _. _ ... M
<br />- - - - ~ -.=stu+--- - __ ._..._ s Fed ~.,rG „e".__.... -.
<br />.. ......xr•., '.:A.T~cH ~.r..E VDw s:ATE
<br />~+S TExx No_ Y,....-K:. ,.... ., ...ra..Y. .« .,
<br />---
<br />-.: ~ ~. _ .ice ~ - -_. --._. _. ---- -- - - - ... ,?DU _... ..-- -. _ - -- -~---- _
<br />S-7tl
<br />STATE OF NE$RASICA
<br />HuL cnuNTv
<br />I HEREBY CERTIFY THAT THE AiOVE I5 A PHO70-COPY OF THE ORIGINAL GfATH CERTIFICATE
<br />FtLEU WITH THE BUREAU OF VITAL STATISIICS. ~~:'
<br />t
<br />.-~{~
<br />-- I
<br />SdBSCRTBED i SMDRN f Y OF _J~i w -E' ,; _ , 19 ~.
<br />&EXE331 ~i;1", Y St E- -:::ura.hF - - _.' ,7
<br />- - - ~ TEnri~ l LD~.ffE~.~lYd ,' ~ .I
<br />- f.Sp CCC:DI P .-~fr...=~a.1,Z ~~ ej C.- -
<br />' u
<br />
<br />
<br />L
<br />
|