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STATE OF NEBRASKA WHEN > THIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE 3/3/201.7 LINCOLN, NEBRASKA T:; DeP ENT Arlene Christine MTV STATE OF MOTH linos USA nem=awl York, Nebraska SOCIAL. SECURRY ROUSER 508-26 -1006 Jl FAC311Y. MAIM. A'M.1A.AroA gnf SItaMAlld rumba) St, Francis Skilled Care Center Sc CITY totto.OP LOCATION) OF DEATH Grand Island REseecs -STATE Nebraska 1p. RAC'E - I..5. VONA EN: Ammon MAAR olAI MONO' II. l:501:000UPATION raw kind al port AS1. &Rag most AT Re OOP Y LEI H omemaker TO FATR6i- ANNE FIRST George O SASED. EVER N U.S. ARMED FORCES? Iv am.p" I I Mips. 91• w Rd Eal.s of a.r1C011 No! -- ---- -- 12D. PfOAMANT AMILIIDADORESS 108 N. Cleveland, Grand Island, Nebraska 68803 SIGNATURES U NO. 214 S E[+ODOF DISPOSITION rs D . :E JQ. 4�e4 a..s,4 t *11 +3 D 0 Ammo Aug. 18, 2000 22a. FLNO AL HONE - NAAE Livingston- Sondermann F.H. e Q Art:We, ❑ U"aw^ --' 0 SwaE� ❑ Pmaam a..AAJRY AT wORND . Irm0911m TWO Ta 27A DATE OF DEATH Ab Ow Yr) # l Ici 9b. COUNTY Hall 11. ANCESTRY 1..9.. MEWL Man Gamin MI <. ISA.c' American ]! DATE OF PUA.Y Ab. L1, y. Yr.N 201701579 STA1EOFsRAS[A-DBrAII NTOFIQIALTHANDHWIANsonn sF7NANt:CAlm3UNAmeT LAST 2. SEX 3. 0.17E OF DEATH AURR1 bay YIMI/ Kilgore Female August 15, 2000 5A - AGE - LaW IMAM - UNDER 1 YEAR LIMIER 1 DAY S DATE OR SETH NUM - OM YAM lab KKiD:OF nR1 5e ALOS + an se HOURS 7 2 December 17, 1927 ........ 6t PLACE OF COMM HOGATAI ❑ INN.* O THER. ® tMSMg Mora! o ER OuNO W ❑ IRpdac. Vi ® Nc CITY TOWINOR LOCATION Grand Island Schleifer Domestic LAST is m **ORMINT - NAME Owen Kilgore is Imes T OR R.F.D. NO.. CITY OR TOWN. STATE OR ❑ Common 22F FUY RAI::HCSAE NORMS ISTREET OR R F.D. NO- CRY OR TONAL STATE an 601; N. Webb Road, Grand Island, Nebraska 68803- 4050 TE CAUSE TENTER ONLY ONE CAUSE PER FOR W -AN. MO PART DUE. TD. OR AS A COJNSEOUENCCE OF e t z? L O- v ,A4ii TO. OR AS OF OTHER SIGNIFICANT CONOIT IS - Cor.."curtly N.I. ANN W .71 . 17 UOTl$R lac HOUR OFINU1m M �N I - A 11Fnm. lnm. 0aW MCAI ❑ 0DA SA COI.MY OF DEATH Hall 12 ® LA11if♦� WIDOWED Lfl [ - A I7010RCJD SS 114O11STRY Christina York,' Nebraska` 214: iZNIETERT OR CREMATORY LocAnord WY OR 70101 PART • W FEMA;E. WAS THERE A SI AUTOPSY Si sea CASE Aa0Wt07131NINICAL PREGNNICT IN THE PAST 3 MONTA6' . r E1LfM19 W '' • ( Nom 1 0.5AM aea OESGP*E How ', occumED . 27b DATE SIGNED AM ON Yr 1 27c TINE OF OEATh x 1% /dv * '7'i .c S 2?. To Pe Om a/ aw WwwMaa. R 6\'r.. a.e Una, Al m. ARRA snoN omt1 !8 : 316 On we Not M wwrr! o./ E .•.IFOFw a NTAO Aix Mom. MOM . #.1N.. Assam pees• 00I airmail* fowl P j P +Sr.,... TA!4S � aM TEN. 29 DID TCSINXO 035 CQM111ElRE TO THE 0657w'. - 39a HAS GROAN OR TISSUE OOAMTON MOOT CONSiOEKD' 3M WAR cameo crameete 20LAND ADDRESS OF CERTIFIER AMYSICIM, WIONEWS PHYSICTNM OR �f T * • f: p; LF14i4 lci'‹ -2 i . t 43c r1 ,rt Grad i'altai , 68803 - - >w , ANTE RISER 11110 Ma. R/ 1 AU618- STANLEY/ COOPER ASSISTAPIT STATE REGISTRAR DEPARTMENT HEALTH AND HUMAN SERVICES ❑ Omar Amor .. SA STREET AND NURSER A11dY MA73, Cara 108 N. Cleveland 68803 13. N NIE ' AM Ow* pie is Owen Kilgore 15 EDUCATION {SWAY aMY NTAAISANINSOgLAME 12th ael�>2, wow mom SLRIONW Geibeibt, Ste CEMETERY ORCREAATDRY *ME Greenwood Cemetery .Ab OA. ITN RAOSEEOTY;MWWTS <: 061196 11-4 o. ..Wm�.Iasr.wAA.a.dM�..r "'Ito 4 1' �t v641 219 LOCITEXI STREET OR RFS OTT OR :001 - STATE