Date of Death: 3a Notes: DOR-OI Date of Birth: (if applicable) 3b Notes: DOR-OI Location of Birth: (if applicable) 3b(1) Notes: DOR-OI of Residence: (if applicable) 3b(2) Notes: DOR-OI City/County of Residence: (if applicable) 3b(3) Notes: DOR-OI Briefly summarize importance or significance to the of Nebraska: 3c DOR-OI Briefly list and describe contribution(s) to the of Nebraska: e & d 3 DOR-OI
DOR-OI 3a Date of Death: Notes: DOR-OI 3b Date of Birth: (if applicable) Notes: DOR-OI 3b(1) Location of Birth: (if applicable) Notes: DOR-OI 3b(2) of Residence: (if applicable) Notes: DOR-OI 3b(3) City/County of Residence: (if applicable) Notes: DOR-OI 3c Briefly summarize importance or significance to the of Nebraska: DOR-OI 3 d & e Briefly list and describe contribution(s) to the of Nebraska: