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e <br />CNJ1 b O C� <br />7� n <br />00 r l s a( D (M O CAI m r zo W <br />D O cn . c rn E <br />N D <br />00 CD <br />Lot 10, Block 28, Gilbert's 3rd Addition to City of Grand <br />Island, Hall County, Nebraska <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUN4N:ERVICES <br />SYSTEIK IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REED_ ON EILr -V4TH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STMT /STIG€llFR�S <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. — <br />DATE OF ISSUANCE <br />rl A EY *hdappf* <br />APR 2 0 2001 ASS STATE AEGIftwk <br />LINCOLN, NEBRASKA HEALTH ANIZ HUMAN - SERVICES SYSTeAU -7- ; <br />200103683 <br />susa�n.n�m <br />,>"` 00853 <br />acs <br />low .. 1 -.� <br />g Donald Sylvester tiosdsrt u . <br />a <br />:Kris <br />S Awn Da, 1M <br />Jary 19, 2000 <br />A�a�M <br />• W IRWIN 1101501111 <br />woseIilew <br />• rrR no ftw <br />!` <br />""" T9 Is <br />September 12, 1920 <br />12'4223 ❑"".' z ��- <br />R <br />0 <br />•�r iC�y�dtf <br />91 BCS 220 ; acoadtisl [ ', 43 <br />M <br />M row <br />Grand Island; ,`.'Nebraska <br />® .. ❑ <br />Ball <br />w <br />r 3 <br />w <br />teb2aska <br />Ball <br />Grand ;Island " <br />1911 Grand Island lye. <br />*G to <br />0/,EE1tf1►ArSOM/► <br />r ,. <br />T.. a WAI!aFpoUEE odepeamd"Ns o <br />•,,!!„M white <br />e <br />abaft Dianne Se Blaahon <br />acs <br />aealrnlrol. rw.1 <br />Coastrnatiarn Painting <br />raw <br />-- e...E.,T.. +•, <br />V 0 EiAM11t <br />r11pE LAST 01111 <br />Jobn` David Goedert (Dec.) Rebecca Beck <br />u <br />� <br />1/27/42 <br />Diems S. Goedert <br />¢1t Graae Island Avenue, Grand Island. Nebraska 68M <br />Ilsat Piibslpc a <br />[},,,,,," 5 QQ101 <br />®�+» Qom* <br />an. 19. 2000 Central Nebraska Craaintia <br />-all %1- Betler- Geddes <br />X" an TOM A <br />Gibbon• Habraska <br />R/ 0 p CiTYDRwom <br />1123 West SeCand, Grand Island, NE 68801 <br />4WV0ftV`OWC^= POLINE NYS►ANDIM br�wwaarMr�11e.m <br />Acute ressimtory failure 24 hours <br />A DF 11..0 a.raaaawrwwM <br />t-aLlmoRM diaease . Years <br />MOP- <br />M <br />1113 <br />FA1t ipMGNt ..A•/1AI1/bMUaT�11r ar NNN FART ■IF FE ..AS A H WAS CASE N1FS/.lED TO <br />MOWN" N THE FAST 300~ E11M/E01 011CDRON[N+ <br />Adenocaroinoma of lung Mo..w6% Y» n w w 11 Na Yr. 1. M. <br />OEE <br />s DAN OF NAFq Ar_ 4 Wi <br />QN HDI CIF NARY <br />US DESCPNK HDW NAO" OCG1/IR®. <br />Q *Am ❑ F-4 <br />i hl{MN ATOM <br />7N FIACEOF IMF •.11�0!'r. W'. /11Ml OCrry <br />.bo11 M.i 1�.eM <br />IN LWATION S1REl OH 11FA HD dn/ OH Y0001 STATE <br />❑ <br />Y. ❑ N, ❑ <br />me DATE OF DEATH Ar D4 wl <br />am DATE 20" A111 vow) <br />7113 TIM OF DEATH <br />January 19, 2000 <br />a <br />f DAN 20" A4. QW w/ <br />7A: THE OF DEATH <br />9 <br />Lc FRONDIINCED DEAD Aft. 0* w! <br />no N10ND, wAD DEAD � <br />January 19, 2000 <br />1:30 a „ <br />E <br />� <br />EM law. ell <br />.aelftow A � (`i ��..�A�" <br />no bFOn.�ro rru aro a�i.eN.Iw��srA «evw.r <br />rtl {`: —l` <br />an0 t <br />CONEDEREW 706 <br />WAS CONSENT DRM.TEW <br />UiE CONTREIUN Ip THE OEATIN ]Oa HIS ORDAN OR TISSUE DONATON KEN <br />® YU ❑ ND ❑ mm" . ❑ YES ® <br />No <br />❑ YES ® NO <br />JO ARDAOMSSOF CERTFWI OWS CMMQ011 WASFIwSICMHORC0INTY A1TOOKY1 ITW@dVPH1 <br />aamehandra Kamath, M.D., YAGNHIS' 2201 N61kWoadxell, Grand Island, Nebraska 68803 <br />