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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT' OF~HEALTH AND
<br />- HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGIN44~ R,FCORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES,,,,XK~F"'l`A~,~2~G`OI~S
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<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. ,~ ,~
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<br /> DATE OF ISSUANCE ]L7 ~C
<br />201003011~`D2'
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<br /> 16 ~01d ~A~ISTA~1(T SPATE RE~TRAR .
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<br /> LINCOLN, NEBRASKA
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<br />STATE CF NEOAAgK6v - DEF:'1pTIMENT QF HEALTH
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<br />ATISTICS
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<br /> CE~ttIFlCATE GF DEATH (, , ~ ,
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<br /> T. OECf:DENT -NAME FIR5T ~ MIDDLE LAST ~ 2 SE% 3. DATE OF
<br />TH (Mdryh, py, Ytw/
<br /> Iva Mama La her Female November 1 1 2
<br /> 4. CITY AND STATE OF BIRTH /M ndt h U&A., rNrtN ColMtay/ 5a. AGE - laM k7irtltdEy d. PATE OF. SMitlt ,AfpN?, lSy; YwrJ
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<br />bannebro Nebraska 1~ n 5b. MCS. DAYS
<br />~ 5c. HDUR MN18,
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<br />7. IAL SECURt7V NUMBER 7
<br />N. PLAGE OC DEATH y~ '
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<br />St. Francis Med~.Ca1 Center fAat A~ My
<br />Grand Island ye ...... , .
<br /> is FiESWENCE -STATE qG COUNTY PG. CRY, TOWN OR LOCATION qd. STREET AND NUMBER /YlrJucWg,tp Ct+dH 4t IMSlIDE CITY La11lt>E
<br />_ .. N~-~~_M~. .. _ _:~.. _ :- -Island 3 6 Reu- R
<br /> +0. RACE • la•C~ WMM. Blatk A111ariGan tAdfan,
<br />rC.l 114pAC'Yy/ 11. AMGE$7RY fa.q.,nauan, MaIiCM, Oarmrn, elc.1 12. MARRIED,NEVER MARRIED. t3. OF SPOUSE /M ^i4, pW
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<br />American WIDOWED, DIVDRCED /Spcxyl
<br />~~ Ma rie~ John J. La her
<br /> +u. usuAL DccuPAT•gN /Uiw kind d.wa aorta dunnq mast
<br />d rn.kiwy N,A awn .l reeimdJ t fib. NINn QF BusINESS tNDUSTar
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<br /> e 11th Grade
<br /> 18. FATHER -NAME FIRST MIDDLE LAST 17, MOTHER - MMDEN NAME FIRST MIDDLE LAST
<br /> Frank NMN Fenton Pearl NMN Knox
<br /> td WAS DECEASED EVER MI U.B~ ARMED aC1RGES?
<br />IVas, m, a uMC.I M TM, qm- war and Wabs a! earvicasy tg. tNFC~RIIAANT • NAtAE • MA7Ll10 ADDRESS (8TAE.E7 OR R.F.P. ~. J., pTV OR tOWN, BTA~.ita
<br /> No _"~"-_--- ahn La her, .946 Reutin Rd. Grand Island Ne
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<br />EMBTIERY OR CREMATORY -NAME .
<br />TOd. LOCATION CrTY OR TOWN STATE
<br /> Burial
<br />2 Nov. 23, 1992 Grand Island (:it Cemeter Grand Island Nebraska
<br /> F. MER - 8 LIC NO. 22. FUNERAI- FIOME -NAME ANC ADDRESS ISTREE'T OR iLi.D NC., CITY OR TpWN, 5 AT ~.~•~p~~~pp-••".,,,_
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<br />2MJb DATE Of aV
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<br />I .. _.. --•- .. ~ 26a. DATE S7GNE0 Mk _ Lyy. Yr.)_ ._ 780 T~ OF ~IEATN
<br />I November 21, 1992
<br />~~ 27b. DATE 5'.GNED /Ab., f?yY. Yr./ 27c. TIME OF DEATH ~
<br />~ 2Lc PgpNOIJHCEO PEAD /W.. Day. Yr.l 21d. PRONpt,NC~ DCAD Il*yry
<br />~ ~ o f NovE~tni:]e 4 , 199 l : C",' : tIK ,, ~ ` ~
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<br />Isa. DID TOBACCO USE CONT O THE DEATH? 3qA $ ORGAN OR TISSUE DONA7h w SEEN CQNSIDERED? 30b. WAS CONSENT 6RANTEtl? ..~_..~,...
<br />C YES NG [7 UNKNOWN ~ C YES rJ6 ~ :' rE5
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<br />!t. NAME AND ~S ERTWIER IPHYSICAN CORONER'S PFIYSICAN OR COUNTY ATTARNEYi /T yep ~r Printl
<br />J°hn A W over Jr • SOQ Alpha Grand I.~lar.:i, Ne 65803
<br />i2a. REGISTRAR
<br />320. DATE FILED SY RE(iISTRAA pM„ per. ril
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<br />The Northeast Quarter (N 1/ of Section Seventeen (1 , In owns Ip en
<br />(10) North, Range Twelve (12), West of the 6"' P.M., Hall aunty, Nebraska.
<br />The North Half of the Northwest Quarter (N1/2NW1/4) of Section Twenty
<br />Five (25), Township Eleven (11) North, Range Nine (9), West of the 6"' P.M.,
<br />Nall Caur~~ l~ebr~KB
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