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MEN T?*SCOPYCARFWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, ff CERTIRES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECO00--ON f kR - WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATTSA&Z_S��WKNCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />200003749
<br />MAY 5 2000 AS&SrJANTSTATE REMSDIAR
<br />LINCOLN, NEBRASKA HEALTH AND SERVICES SigfMi
<br />STATE OFNEGRAsxA-oEPARTmeffoF"FAUN "�,
<br />SUPWAU OF VITAL STATNTICS
<br />CERTIFICATE OF DEATH 95- 9570
<br />1, 40PEOM.18"M pop MiOOLE LAST
<br />2 SEX
<br />DATE CF DEATH AUW Dj;
<br />;v
<br />I
<br />August 23, 1()95
<br />AAA EE1M SA — o
<br />UNDEPIVEAA
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<br />6. UAW OF OWN A*--" Dft *W ---
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<br />Nlebraska
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<br />June 11, 1938
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<br />WAN PAST MODLE LAST
<br />,F MOTHER FIRST "DOLE MNMN SUFKAME
<br />Lloyd R. Razey Sr.
<br />Eva Collins
<br />"n
<br />ft OffiXIMANT -NAME
<br />a',
<br />Lorna Razey
<br />foan"ff WMAMADWESS jSTFW0R#tFD 1410,01YORTOWN STATE DPI.
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<br />�Apfel-Butler-Geddes F.H.
<br />01-- Ell
<br />Gibbon, Nebraska
<br />1S"WF1 00 RF a Poo CrtY OR TOM STATE, aM
<br />1123,14 Second Grand Island, NE 68801
<br />M 14
<br />TQ DRAG A OO"60LOICS OF
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<br />DIE TO 001 AS A OUNWOMENCE OF I I
<br />SKftPICAPFTOOF4DkY-OMS OWOW060 Mftd.0bWMftVW
<br />PART 0 OF FEMALE WAS THERE A 2.
<br />AUTOPSY
<br />25 WAS CASE REVERSED TO MEDICAL
<br />•
<br />PREGNANCY *4 THE PAST 3 MOA1THV
<br />EXAMPIER OR CORONER'
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<br />2ft DATE STONED AAP.Dov n l
<br />20b TIME OF DEATH
<br />9-8-95
<br />5:05 a.
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<br />MEN T?*SCOPYCARFWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, ff CERTIRES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECO00--ON f kR - WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATTSA&Z_S��WKNCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />200003749
<br />MAY 5 2000 AS&SrJANTSTATE REMSDIAR
<br />LINCOLN, NEBRASKA HEALTH AND SERVICES SigfMi
<br />STATE OFNEGRAsxA-oEPARTmeffoF"FAUN "�,
<br />SUPWAU OF VITAL STATNTICS
<br />CERTIFICATE OF DEATH 95- 9570
<br />1, 40PEOM.18"M pop MiOOLE LAST
<br />2 SEX
<br />DATE CF DEATH AUW Dj;
<br />Lloyd Richard Razey Jr.
<br />Male
<br />August 23, 1()95
<br />AAA EE1M SA — o
<br />UNDEPIVEAA
<br />I
<br />6. UAW OF OWN A*--" Dft *W ---
<br />�DA
<br />Nlebraska
<br />j-;:j--1t4,hftE
<br />June 11, 1938
<br />�trpl!k
<br />ft PLACE OF DEATH
<br />El
<br />506;-50-4797
<br />w E. Ow.. 0 wwww-
<br />ww
<br />7St., Hospital
<br />❑ OQ% D.. /Spara,
<br />s: EM Eaar Sd 9119MCITYUM(IS
<br />OOUNTYOFDEATH
<br />Ift
<br />M ❑
<br />Doualas
<br />„STREET ATM TRIMMER
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<br />47 Venus 68 110
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<br />F
<br />F2 ORCw
<br />1 Ioorna Elrod
<br />IRS iftwoccupow"
<br />SUSPIESS WADUSTAT,
<br />VOLICATON
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<br />Auto Parts
<br />Eb.,wf s fvw.rr 11,21 C~
<br />12
<br />WAN PAST MODLE LAST
<br />,F MOTHER FIRST "DOLE MNMN SUFKAME
<br />Lloyd R. Razey Sr.
<br />Eva Collins
<br />EVER.a US WMXW PORCM
<br />ft OffiXIMANT -NAME
<br />a',
<br />Lorna Razey
<br />foan"ff WMAMADWESS jSTFW0R#tFD 1410,01YORTOWN STATE DPI.
<br />47 Vemis Alda, NE 68110
<br />a Lprw NO
<br />00'MnON
<br />21b DATE rc
<br />CEMETEPWORCAEMATOF. NAME
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<br />8/26/1995 Central
<br />NE Cremation Svc.
<br />sk fwakulkow - own
<br />210 CEMETERYOFICREMATORYLOCATZH CITY OR TOWN STATE
<br />�Apfel-Butler-Geddes F.H.
<br />01-- Ell
<br />Gibbon, Nebraska
<br />1S"WF1 00 RF a Poo CrtY OR TOM STATE, aM
<br />1123,14 Second Grand Island, NE 68801
<br />a Pow SINAMAINEZ9 IENTER ONLY ONE CAUSE PER LAIE Ff at ft AND 4rIo
<br />TQ DRAG A OO"60LOICS OF
<br />rovi
<br />Cjt::r CL L,
<br />DIE TO 001 AS A OUNWOMENCE OF I I
<br />SKftPICAPFTOOF4DkY-OMS OWOW060 Mftd.0bWMftVW
<br />PART 0 OF FEMALE WAS THERE A 2.
<br />AUTOPSY
<br />25 WAS CASE REVERSED TO MEDICAL
<br />•
<br />PREGNANCY *4 THE PAST 3 MOA1THV
<br />EXAMPIER OR CORONER'
<br />V4. 10 -5"1 Y_ El N. M
<br />VM rj NP
<br />Y. Np
<br />aft DATE OF INJURY Jw Dwy "'j,
<br />NOUFI OF PULP" nd 01-SCFAK NOW PL#URY OCCURRED
<br />12ft
<br />0 SPOW 0
<br />24 R&AA" ;aW
<br />==Vv A= Wat,
<br />2ft LOCATION STREET OR RF 0 NO CITY OR TOWN STATE
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<br />120
<br />-
<br />rft Q&TI of DEAIN AM Cw -s
<br />2ft DATE STONED AAP.Dov n l
<br />20b TIME OF DEATH
<br />9-8-95
<br />5:05 a.
<br />rft OATS EIYED job 0► »1
<br />fFT i;K OF DEATH
<br />2ft PRONOUNCED DEAD PA. D.K. W
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<br />"AC"' THE DLATW 0.4 Doe"noN BEEN CONSIDEREOF
<br />WASZORSENT GRANTED'
<br />130b
<br />❑04000,100" 40
<br />❑ YES )N No
<br />AM ApOliii OFC&ATF611PHYlOAµ CORONEA3 PWSICMOA COUNTY ATTORNEY{ jFpFm
<br />a "n, M.D. 4840 F St., Omaha, NE. 68117
<br />no 1§0013MAN
<br />01 Aft, P. )?.
<br />X46W9
<br />I J0b DATt ruo0v Tom Afa, my Yl
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<br />LEGAL: LOTS FORTY SIX (46) AND FORTY SEVEN (47) IN ARGO FOURTH SUBDIVISION
<br />IN THE VILLAGE OF ALDA. HALL COUWrPV- Mr.nPacva
<br />
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