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<br />STATE Oi iIEMASKA-OEtARTMEMT Oi HEALTH
<br />8 ~ ~ ~ ~ ~ 4 ~ ~ u~EAU or wTAL sr~nsr-cs
<br />CERTIFICATE ®F QEATF~~.,~3~
<br />I
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<br />SHEH THIS. $$' CIIRRT"~3-{:THE RAISED SEAL OF THE KLBRASKA
<br />STATE DHMEHT OF ~1.TH, IT CERTIFIES THE ABOVE TO BE
<br />A TRUE Ct%~X;-OF AN OR1~BfZNAL RECORD ON FILE 4fITH THE STATE
<br />D&PARTMEDI?° t!F HEALTH~•`'~EUREAtI OP VITAL STATISTICS, G-HICH
<br />IS THE LBCt~7M, DL'PQ1Si1f8~T POR VITAL RECORDS.
<br />_ ~ i1
<br />DIRHCTOx OF VITAL STATISTIC. A1~.,~SSISTAIS'i' STATE REGISTRAR
<br />LINtR3LN, NEBRASAA T:ssttQd februarv ii, i~Bl
<br />J
<br />-Nar-"" ~.-'-iti3 - w4t-'"- 5TR-bi~-. Dat. Yr~l
<br /> Erna Pearl Faustian Female rebruary 1, 1981
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<br />-Fn.o. WI:u, ~ K~~•.Im11an.Mp,wn, AGf-,an tr.+-O.ry UNDlt . i~!_,___AS UNDft I DAY DAR OI RRTN (Ab.. Dn,,TrJ
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<br />4 rt f/.O.l Mpi. DRYS MoU•s . rNNS:
<br />En 1.is~i Scot r ~ .. 66 ... Jan. 26 1895
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<br />aOC1A01fCUliTYNfYYft- USUAtOCCttrATtON (Giw i:M.lw.rt d..0 d..:np.0/ t1NOd W11NF31011 lNWSTfY CWNtY OF DEATH -
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<br />TT_ 518-58-1461- ,,,- nou.sewz~ ~- , .home , Che erne -
<br />,TOWNOflE1CJtTIC:'~~w'•^~ NOS1Bf LI4T t4t1T1 NpSNTAt tlt OTNE[iNSTOfUT10N-Na.r INAS[iw.iM.n, uf1OR M-,xII.T.AsMnODA:
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<br />Sidney es N•r °„~dgepole F-1a~a Rest H ~ -in anent
<br />YSWfN[E-s7ATE COUN/1' CITY. TbwN QtCCfUT14N S/QB AND NaiAMER - IN~7lfNT-UANR-
<br />,~ .~iebraska „~ Cheyenne ,,,. Sidney ~,, 15th and Toledc ;,., eB
<br />Edward
<br />WM OECIASfD tY[!' Bi u.i AtMf6 YBKEST
<br />,a -ri~i
<br />Burial `,.. 1~~81
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<br />~rE 69162
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<br />~,.~i~ 7010 _ _
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<br />Eastman ;,, Esther Wolter
<br />DtMANT-NAME-tt1ATICINSNN-MA1lDt6 ADDtE1S (srrfT Otte o. r0., an d•YOwM, STAiI, t,TI
<br />~,arl iaustian-son-t.U. Box 1`17-Ifarame,WY 82070..
<br />~re+notceeMASOtr--NAME tOCAS,oN cmdtOwN srATE
<br />Grand Island Cemetery ~,~,.Grand Island,Nebraska
<br />~lf~lL MOMt -NAME FNL ~DOtfSS sit,Ni Oe B r 0 MO Cm W Rnw. iTat[. SM
<br />ehrig ~ onruria~al Home - Sidney, yebr. 69162
<br />y~ ry~yl[ .r M...Ir.V A.+hbwMYY.M-
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