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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEA1,MANONUALM SERVICES SYSTEM; R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGML gMOftmdmE WITH IM THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL AIF1s±ICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE — = $XOPER MAY 2 11999 ASsISTA)ffST^TEPiEdSrRAR LINCOLN, NEBRASKA HEALTHAND ESAYSTEM n cn o -� C D M -c o o m -n Z z m D a) r D D 6yo � n y F r STK[80lTQ ArMANDENTOFMALIRAs+UFR11 MaRv1 mfVil1NMAMSUM)i& it T _. - VTTAL3rAiiS= G 4 914 E" r � CF TmcATE OF DEATH , " 98 " Y. OF t. OFEi00ET /MI! h F n p fNST s �E a SEx a DATE of Quiff way EATr w.lt �CttrANDmATEOiewTEE RIFaTr .rrmu+rF r PAGE - �6 N. Howard Island Nebraska 68803 •' E •SIfiNATIMFr L _ ^� ?r■ EETNDDOF OIVO I- 710 DATE tEC CENETEEEV OR CRE NAtONr NAME I �Rfr ❑ _. it 24 1998 Grand Island City Cemetery - 71a CEEEETERV ORCAEMATORV LOCATION CIT r C)N TOWN STATE )h FLINSPALWHO14 11 El Kleine Funeral Home D o+A.. Grand Island, Nebraska 77O fUNEPALMOMEADORESS ISTT1EJETOA.RFO ND. OTV OR TOWN STALEM 3213 W. North Front St Grand Island Nebraska 6880 M.M.N �"+' 11REEp1ATE CAUSE C rFNTER CMV O'NAfE CAUES�E ENE Ip AND I'll tI.TA.eII oNw em PAM ^ \�`, laRSTETO■f Er+oEn/run' LMDER/wr •arE s1111N AE■wGlFrYwr T R1 N Utica =South Dakota TM nJ 1■ NOIAOF NA/Rr Ur OCCURRED f NAAY Ab L. - M DEATH 7. SOCW UCWMIASMEIItr. ;' '. ', RACE Of EEDEMTAI - p .�..,* onler C D n n D.�* Yw � No � I. o aDOA s `,Ii c M T F DEATH ~ i FIUNOIC �1 :rE AD A HI rr 7Ba 4 DATE SGNED r 7K 2 IO.i� u— ■ k �CITr: TOVMI On EOCAIION Of DATE IN mom CEW LIN'r5 k COINTr.OF DEATH DID 1OBA rr ® No mall land h RESIDENCE -STATE E4 COUNTY ft r.TOWN OR LOCATION b STREET ANO IAJAISER M'AIF%VZ4P E M tom CITY LMTs lam 71 NAME AN ADDRESS OF CERTIFIER.PNYSICA.. C RS PNYSK;IAN OR COUNTY ATIORNt r I�yp R.y Yw oftD to RACE • Ny WNM. SkKk M meo l i/. ANCESTRr 10 V. ROM VOWA l.OWM A.Nt 10 17.L7 MAmEO o wlOOwED t7 NAME aP - II A.AF v+Al■aI■lnrTw wit'0■OEN White : 4, , ,German /Irish m!! DI ED Helmuth Maul u■ QSUKOCCU►AT10N IoM drM aalM.M■TOAM+T ^ 15 to MhDOf EUl4SSMDUSTIIV ^ �((J 1 is EOUCATON ISDKM aW POW" WO Co OMbW brY 1O. rT C rI�n�•r EW m" S■ca OMP d■M■VIti ME /F.WWI l�/iA. m }. ocwt F--A INLET - MIDOLE MAIDEN SUNNAME ' O r m WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEA1,MANONUALM SERVICES SYSTEM; R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGML gMOftmdmE WITH IM THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL AIF1s±ICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE — = $XOPER MAY 2 11999 ASsISTA)ffST^TEPiEdSrRAR LINCOLN, NEBRASKA HEALTHAND ESAYSTEM n cn o -� C D M -c o o m -n Z z m D a) r D D 6yo � n y F r STK[80lTQ ArMANDENTOFMALIRAs+UFR11 MaRv1 mfVil1NMAMSUM)i& it T _. - VTTAL3rAiiS= G 4 914 E" r � CF TmcATE OF DEATH , " 98 " Y. OF t. OFEi00ET /MI! h F n p fNST s �E a SEx a DATE of Quiff way EATr w.lt �CttrANDmATEOiewTEE RIFaTr .rrmu+rF r PAGE - 16 fAT1 - T.I7■I■ • Erw w m MIAI 1 IE V.■ EN+■`M ■ Idda ■ d TI■I. I Hp INFAIRWY SS IsTREET QA R F D NO. CITY OR TOVME: SEATS m �6 N. Howard Island Nebraska 68803 •' E •SIfiNATIMFr L _ ^� ?r■ EETNDDOF OIVO I- 710 DATE tEC CENETEEEV OR CRE NAtONr NAME I �Rfr ❑ _. it 24 1998 Grand Island City Cemetery - 71a CEEEETERV ORCAEMATORV LOCATION CIT r C)N TOWN STATE )h FLINSPALWHO14 11 El Kleine Funeral Home D o+A.. Grand Island, Nebraska 77O fUNEPALMOMEADORESS ISTT1EJETOA.RFO ND. OTV OR TOWN STALEM 3213 W. North Front St Grand Island Nebraska 6880 M.M.N �"+' 11REEp1ATE CAUSE C rFNTER CMV O'NAfE CAUES�E ENE Ip AND I'll tI.TA.eII oNw em PAM ^ \�`, laRSTETO■f Er+oEn/run' LMDER/wr •arE s1111N AE■wGlFrYwr a #, A , .. �• msE a MOs E OAVS k NOUn6 t/IS t 5 1938 Utica =South Dakota TM nJ 1■ NOIAOF NA/Rr Ur OCCURRED f NAAY Ab L. - M DEATH 7. SOCW UCWMIASMEIItr. ;' '. ', RACE Of EEDEMTAI - p .�..,* onler p.IN■E.q N■+0 LI Y D.�* Yw � No � I. p..ACAlTV.EMFA■ x. Mn/■IfiftS"MIMAI.Mq aDOA s `,Ii c M T F DEATH ~ i FIUNOIC �1 :rE AD A HI rr 7Ba 4 DATE SGNED r 7K 2 IO.i� u— ■ k �CITr: TOVMI On EOCAIION Of DATE IN mom CEW LIN'r5 k COINTr.OF DEATH DID 1OBA rr ® No mall land h RESIDENCE -STATE E4 COUNTY ft r.TOWN OR LOCATION b STREET ANO IAJAISER M'AIF%VZ4P E M tom CITY LMTs lam 71 NAME AN ADDRESS OF CERTIFIER.PNYSICA.. C RS PNYSK;IAN OR COUNTY ATIORNt r I�yp R.y Yw oftD to RACE • Ny WNM. SkKk M meo l i/. ANCESTRr 10 V. ROM VOWA l.OWM A.Nt 10 17.L7 MAmEO o wlOOwED t7 NAME aP - II A.AF v+Al■aI■lnrTw wit'0■OEN White : 4, , ,German /Irish m!! DI ED Helmuth Maul u■ QSUKOCCU►AT10N IoM drM aalM.M■TOAM+T ^ 15 to MhDOf EUl4SSMDUSTIIV ^ �((J 1 is EOUCATON ISDKM aW POW" WO Co OMbW brY 1O. rT C rI�n�•r EW m" S■ca OMP d■M■VIti ME /F.WWI l�/iA. a _ N .e INLET - MIDOLE MAIDEN SUNNAME 16 fAT1 - T.I7■I■ • Erw w m MIAI 1 IE V.■ EN+■`M ■ Idda ■ d TI■I. I Hp INFAIRWY SS IsTREET QA R F D NO. CITY OR TOVME: SEATS m �6 N. Howard Island Nebraska 68803 •' E •SIfiNATIMFr L _ ^� ?r■ EETNDDOF OIVO I- 710 DATE tEC CENETEEEV OR CRE NAtONr NAME I �Rfr ❑ _. it 24 1998 Grand Island City Cemetery - 71a CEEEETERV ORCAEMATORV LOCATION CIT r C)N TOWN STATE )h FLINSPALWHO14 11 El Kleine Funeral Home D o+A.. Grand Island, Nebraska 77O fUNEPALMOMEADORESS ISTT1EJETOA.RFO ND. OTV OR TOWN STALEM 3213 W. North Front St Grand Island Nebraska 6880 M.M.N �"+' 11REEp1ATE CAUSE C rFNTER CMV O'NAfE CAUES�E ENE Ip AND I'll tI.TA.eII oNw em PAM ^ \�`, `pf. _y- IM v, \iM CPI. AA �_ Y J ?" ..r. •ae.N... mFel �n DUE TO AS A CONSEOUETFCE of , n Coo Lew -.0.7 AJ .. - -- _7, h.N M ITIN.II OrMM .M •Ywll DUE TO CVI AS A CONSEQUENCE OF NI P�lOTNER S1GEIiK�F/T CONpTIQNS C. Iwo +'arI■OIAFI,bMaNNtAI rb11.IFl.a PART W K FEMALE WAS T/1EEIEA AUTOPSr WAS l.A1E NEFEARED TO MEpCAI PREGNANCY N THE PAST7MONTMS� %AMINFR OR COATYIEN• ■ �•( lAPS 10.5AI YM - — Nt UZ --F] . TM nJ 1■ NOIAOF NA/Rr Ur OCCURRED f NAAY Ab L. - ❑ A".— ❑ lWa■w— M _.._ ... ❑ ❑ P.rvNlp i6.'.All1RY AT WORK 261 E ■ M y. +r... IA'or 17bp LOCATION STREET '*RFD NO I.IIYOQTOWN STMT oke ❑ NPrn'df I^••'•ARAIO' Yw � No � I. 121. EM I *�51GNEEI M' Oar r, z■n ME f DEAIN 1 PATE OF DEATH rAM EH. Yrl s `,Ii c M T F DEATH ~ i FIUNOIC �1 :rE AD A HI rr 7Ba 4 DATE SGNED r 7K 2 IO.i� u— E n.Wl xr •ea r TII. � aAY m Luc. W ar. n .v . ' Y M. CYI K Owww d nA� na u m.Nq■Irn � my opnw rinaln r.< ✓•.a Y ro Iro a k n..n aa. ra plACe .na n,e n.l. cwa«s xAl.a causelsl sHW DID 1OBA .5 Y%7 T1k1 SQu ..M TM. � _ CO USE CONTRIBUTE TOPTM TNI HAS OFC,AN OR TISSU f l A ATIDN EN CCONSIOERED' C NT GR 19�E •k5 ES L{.d 1:1 YES NO UNL 71 NAME AN ADDRESS OF CERTIFIER.PNYSICA.. C RS PNYSK;IAN OR COUNTY ATIORNt r I�yp R.y Sitki Co mp 2116 w v 6 ._ Mp n - I2a REGISTRAR 77D WTE FRED Br nFC,ISTNAR , Dir MAY 108 V LOA O N Q. 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