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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALT SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGWA THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STArl; THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE FEB 11 2000 ,� LINCOLN, NEBRASKA tAj [A� HEALTH AM: ft STATE OF NEBRASKA — DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH tee- •�. o 1 w ••`••�'�'••, ^^"R —of MKIOLf --- lA'Si —�_ 7 Eli 7OAfiW DEAN /AAs+11. O•r. Y••ri '� Marjorie Levinia Sorensen Female December 19, 1992 1 Y AND A M11 M !M nr n U �A. Aw" mw"ry w AGE . u� 4wo4ow 1JM[dA f OAY • DATE OF BMTH tAMUI p•F, -•Ar/ -- Ord, Nebraska Irit: Oe ►qe» DArt k NOuRy 4wi tai September 1, 1908 7. ' C N w PI ACE OF DEA7H 484 -12 -9416 JIPMT& k: Ll MOYbttMK O DOA _`- .Q M c wm"NO" n wwo-ce c O•wrdMFSM1 ..� -_ _.__._� _ � -_. T_.___.� _ - -_ -. -- M ACgflY. N•r11• IF wof •ItARI•oa. •++� •••M •'Ia 1Yw►o•,1 k CITY. TOWN OR L ATION OEATN w INZuO�CITY LMKI■ w COUNTY OF OU /H '�""`� St. Francis Medical ~ ""°' Center Grand Island, Nebraska 1fes�" Hall w TA i M COUNTY •t CITY. TOWN GR t OCAI h 1b IITFN�t ANO NUMM tlkpq.y Jp (qF.l M INGM It r 1 Y1tS Nebraska Hall Grand Island 1,618 North Elm gall, r " +0 •N0. WNb, tbOt MT•rNrl lrlOrl, T 1 ANCtB r I• t.IMAM. W,MM. 0•'w1•► rt 1 17 A41Mtto NivER MA -t —. I ] NAMt GO •F'OUai iI f•• iKrO4TOM why"! l ican U6 Marcie° 'R`E "`f°°f`"" _Albert = L. Sorensen I" p�U�/WpAtI�� ArI'T��ION kftl Of •Aal•OUn'p ��eM IM woo EIU6/hE SM/DU91 Nr - - dOUSan me8tic 1i• . _•n.._ lll&K-kWi r+3lon1f%h1 ap�AlippitiWrapp�MM4_.�, %Ot.iFfl.l49.1 CihlC If PATHER .NAVE M OME LAST 17 MOTHER - MAIOEN NAME �� -1. " -_MS FT -y am_ -y- — 4K101t � '"'"'�'� -'•'" John Alonzo Wentworth Margaret Ramsey 1•. WAS CEASED MR IN U 0 FORf15+ i"�. 1 N1! '�"-""'- ^.-'---- ---• -- _--- �-- .-- - -�-,_ IYN�.ro. a unt.l (t Y••. rm w"orw r mftvnl i dWANT NAME , 4AIW1A ADWKr6 1 —13- 111 cXr N I D !+O t,n r OR t {,WN. STATI illl _ EVp Albert Sorensen 31b1,1U N Elm Grand Islam, NE 68801 70A SUAML. 010themn, R•w+0YI1L aft bAft "w'"YORC MATOIIY hA4t 2M LDCA TIL)N r.TYOR TOWN SIAtE `��,� _ - -� >�iirial Dec. 22, 1992 Ord Cemete rY -Ord, Nebraska 7/ E _ . MONATVRS S JP iFUNERAL NOME • NAME AND ADDRESS ISTNEET OR N F O W3 CITY OfA TOWN iTA1i JWJ "/ Apfel- Butler - Geddes 1123 W 2nd Grand Island, NE 68801 tt/� IENTEA ONLY ONE E PIER L1W (•A 101. AND itll —41 Ewh.n DAM Mp a� C' O AS A CONSIOUIENCE GYM DUE 10. 001 AS A COHSE OF ' rvM•rrN 0•o.••n OwW Awa aWn PART OTHER 9K1WFM.M(T CONdTpNE - Cowafory corr1011t^D b 0•t81 OIA np M.MC PART IN IF FEMALE. WAS THERE A N AUTOPSY M WAS CASE WFEARED TO MEDICAL PREGNANCY IN THE PAbT f 1467 /Spey r / EXAMINER OR COfKMfR� Y" 2: ✓ I Is.:w4y r.E e) 2" N(;, ACCOENT. HACIOE. HO•KOK UNOET. 2W DATE OF NAM (Y•.D•y Y,! 262 HOUR OF w,IMITr lea DE If0'W KN,itY OCCURAED� OR PENOMD vivESTIOATION rSF'•tlli! 2•• NMIY AT WORK 2M RACE OF ff4UURY . AN hw". f•mL u••L %cwV. no LOCATION STREE I OR R F D NO CITY OR 70" STATE /Spey YM t. NN 010010 01 d&- rt. /Softy, iF DATE OF OEATH Aft. Oy. Y,I I 2e• DATE SIGNED /Ab- 0•►. v,) 200 TIME OF DEATH Qoces r 19 1992 a 6 Y 2711 GATE SIGNED PAR. Dry, Y,1 272 TIME OF DEATH Zit, PRONOUNCED DEAD fw Dy, r.1 2fla PRONOUNCED DEAD JN~ ` Y Decembe ,1992 11:10 AM ]L�9 E 27a. To M DW of a•tn E 12 F r tti t.n•, fMe• Awa au• a •r 6 2w. On P* b"M of Raft w� &W telr•IN rWa '� B W two. a•N WWI 00 w car Dow. m W wv+ a•re ooar.•a r o4t• •Iw aw b M tau•NR •1•fq •+1a Tr• i.-T •na Tf• 20L OD TOBACCO USE COXTFWM TO THE DEATH HAS ORGAN OR TISSUE DONATION SEE Jop Wf5 CONSENT GRANTEO1 O YES O UNKNOWN O YES `/y� /� S1. NAME AND ADDRESS WA fPFIYSK:AN. COAONEWS PHYSICAN CFI COUNTY ATTdM.Fr1 �T.....� . f-, -- Dr. John A goner 8O q7 a Grand Island, Nebraska 68803 2A REGISTRAR 72D DAif FILEO BY REGISTRAR JW. O•y. DEC 2 8 199`2