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<br />STATE of pf6RASRA-DEPARTMENT OF HEALTH ~ ~ ~ _' ~ U 3 3 3
<br />DUREAU OF YITAL STATISTICS ~
<br />CERTIfiCATE OF DEATH ~' _ ~, 2 s
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<br />E NT-NAME t~ MIDbFE iAST i SFX DAVE Of DEATH (MO.. DoI• Yr J
<br />James Nickolas Car
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<br />1 19 1981
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<br />LACE-(.p.. WtIN. Ilxt.w~^erKa^OmGINJDESCENTfe.y.Pafien.Meri.en.-ITA-Of-I...E~UNDE~_: YEAR- UND RIDAY-_~D IE~TN (Mo., OaT, rrJ
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<br />MINS 11
<br />Ind~on k)fSpe.aTl ,GNwn k IfSPer./,) '!Y„ 1 II MOS DATS ~ HOURS
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<br />Greek_ ? 1 '~. 57 lab ia< IT Deo. 23a~3
<br />4 AND STAT[ OE IIRTN (d ^N ..USA, 'CIn2EN ~ WNAt COVNYW MARtlED, NEVER MARRIED- 'NAME O[ SPOU}E (IEr.fh, pro wNae^ ^ya)
<br />i WIDOWED. DIVORCED (SpeTify)
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<br />Gra_*Ed Island. Nee p. IIS ilb "' 11.
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<br />IVSUAI OCCUPAnON (Gi.. l:nd et~W den. du..np ^rod IUND OF BUSINESS OI INDVSiR
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<br />SOCIAL 3FCURITf NUMIE
<br />k~np lih. ewn.l •en•edi COUNTY OF OEATN
<br />Ix Ob-zo-aa3~ ~t~P. $et}xed SCG Ilb ~83( .~Q.ri/~(,` Ib. al,l ri6llllt~'
<br />CIn', TOWNOR tOCAT10Fl Qi DEATH INSIDE CITY lIM113 NOSPITA[OR OTHER INSTITUTION-Have 111 nef in..M.r, EMOSE. Ot INST IMf.oN DOA,
<br />IiSPenTY Ye. er Nel pore dreN ^^d nVwberj DuNN+e^uRrr B._, ,^#yK.^r fSPer•Y,1
<br />I.eSlrand Island j,4
<br />Yes_y,.a.~t. ~'r rtcis 1•ie~ical ~,.. tie...
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<br />RESIDENCE-STATE -if UNTY GIT'/. TOWN pR LOCATION
<br />SiRF[T ANO NUM[FR tlVe NSIDE C[ry FIMAS
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<br />(Sp«ilE to e• Ne)
<br />ise liehT'aska ' Iss Hall ! I, ~ Grand Is~~ j ua. 1716~1Ty~.. Grand I u.. _
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<br />A -NAM 1 MI F ~
<br />: MOTNEf-AUiDEN NAME /11!]T MI
<br />I . Stie Las Caredis I, Elaine y~ --
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<br />WAS DECEASED EVEf IN U S AIMED fOKEST I INFORMANT-NAMF- FFLA TIONSNII-AU11lIN0 ADDRESS fSiRkt}OlrR
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<br />RVfiAI, C•e.^erion, R.wo•eI~O.TT ~~ ~CfMFTERY OR CRFMAipRY-NAME It ATION CITY OR SA
<br />7a. Burial ~xDbA r. 22 1°8 xort~~tlaWn _:emorial P'Trk ~xoa r,TA..TI TAlnnra,T,u°~_:
<br />EMRAWf!-SIGNATURE l SK(NSF NO ! FUNERAL NOME-NAME AND ADDRESS rSTt![T Of e, p NO. C.TT Ot IOWN. STATR IV1
<br />] _ -% -r. ~I "' "~'/^.l:: e`:L%72 ylVlll~ 4GI3~1~,~021d~'r.'..'i71n S S_ ~inrT ~v ~l~(SATlI F_ ~:TATt[j TAl AffL) _IJ :-:.
<br />' DAtt F DfAtN (Me-, De,, Y•.) ~ ~ DA E I NED e. ,. r..) i N f DEATH
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<br />xxe April 14, 1461
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<br />:^ DAi IGNfD Me.. be,, Y•) HOUR OF DEATH
<br />~~ !, PRONOUNCED DEAD
<br />PRONWNCED OFADlNeN)
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<br />3:49 am
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<br />NUAf ANO ADDtf13 OT CERili1ER IPNPSK IAN, CORONER'S eNrSICIAN OR COUNTY ATTORNEY}lT,pe e• pr.wU _
<br />x, C. D. lc~rath, „^ D ., 72y iiort'r: Custer dve., Gra.:.d Islam , ide, 6&801
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<br />WHSeN_'TIiZS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />STATE DEPARTHEHT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A TR~JE COPY OF~~i1Q ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPA4~TM$NT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS T2~,:LEGAL,B£POSZTORY FOR VITAL RECORDS.
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<br />DIRECTOR OF VITAL STATISTICS_[~~SSISTANI' STATE, REGISTRAR
<br />LINCOLN, NEBRASKA 155ued ipril 24, 14$1
<br />R~~yarding
<br />S~Ith 6 fF>ct of Lot 81 & all of Lot 81 in test Lawn,
<br />an Addition to tl~ City of Grand Island, hall County,
<br />Neiaraska.
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