|
<br />
<br />
<br /> ~ n n
<br /> m _c a
<br /> m
<br /> A (f)
<br /> C
<br /> m LM
<br /> n x c. n t\.] c
<br /> ~
<br /> rr ~ --4 m a
<br /> C=)
<br /> (T; C-45
<br /> M D' ca CM a
<br /> cn a rv ~--a
<br /> ILr)
<br /> m
<br /> [d7
<br /> ~x~~ ;37 ~ !,3 7j- ,c,1~~C. ~7~ - ,~/a c1~.. ~ ' in .S'tltt.d~►L~
<br /> F~2 ~:<~..5r'c bdr• b~-~«`~r a.. fit`" /uia~N~ . ; . , ' acs
<br /> WHEN MS COPY CARRAES THE RAISED SEAL OF THE AnSRAWA' 1lEA[:Mwi;Pi~.~CES
<br /> SYSTE-A4 IT CERTFIES THE BELOW TO BE A TRUE COPY OF TI&COGINAURECORD ON FILE WITH
<br /> THE NEERASM HEALTH AND HUMM SERVICES SYSTEW VITAL;STATISTMS SECTION,-. WhVW IS
<br /> THE LEGAL DEP'OSITORYFOR vrrAIL REG'ORD
<br /> DATE OF ISSUANCE
<br /> APR 2 7 200 a+± COOPER
<br /> rf y'::. A.=sTANT3TATEREG0TRAR
<br /> LINCOLN, NEBRr SKA 41 0 O O r i] HEALTH AA D M MAN SERVICE'S SYSTEM
<br /> `•TATE OF NEP R-•.SKA- DEPAI{M h . OF FMU, M AND HUMM S3 V6nS nNASM AND SUPPORT
<br /> MALSTAT!S11CS
<br /> CERTIFICATE OF DFAni _
<br /> 3 JA!4(,f0EA111 -k-.1- VW
<br /> Clarence. Francis Burris I Male ' April 21, 2000
<br /> ArvoiiAiEGF ;y:li.i .nl., triA '.A-w.w-err ~L xvE-~a.v+cA. ~.r-aEii TvE.W u^rJEN,UAr 6TJA7Ea B.a to ,AUrc+a.. r✓✓•T
<br /> 1{ambletrn, Sr U05 aA+snOUgy w•%~ Kansas R1 J;.?y 20, 1418
<br /> t •
<br /> - S.i~~NAi~:.1+?i,:nuW7CN~ eta FtxCEpw :>£w[r.
<br /> I 1--01--2984 0 ,~sa, •dor. Oi EFI N✓YtJ oy
<br /> 6AFF it(i:iiv-;.m•,_._._._...__. jr'.r .~vrrar. ~.n•utn ..c +wrr7.i~~ ~ ~ Ep (sa-„sdr ❑ Ae~pA~ce
<br /> St Francis Medical Center s a^ :0.vh
<br /> rk [~fv r(irr^i Cn C~~n.rKw Cr C~J.rH -.`ljf CJ:v:lw'S 1 er Ct7u'+1r CIO CfATTl
<br /> Grand Island rho Hail _
<br /> ~'H tuCr£NCt AttT~ T~4rr Cih.Nir~•~•• CIT• iayYf. CA7 cVJ(TC„ W S'W.ETAAbNVUSEFa ;I~vr.sn~I,+<ar. yA ✓ayi;E C"""t5
<br /> i.rUr3Ska Hall Grand ~
<br /> _Island 21.2Z Circle Drive d88Q'[T)
<br /> ~+~Tl:µ.; :C9 M7*K d•ti. •^wSa~Irf A^ fi 11 NalE4:~Y.,C W.M1 W yap. Ge.w~r.1 YY -•~+.•1.' NAfiFCf:l) ,S 1 W00"Ep 17 hAM1FE Q~~F'l lid. r.al ywrt4W^+~WrW;••••.
<br /> elc; r A; ~',GCnw~ ` 1:1 vEVFiI tlL1^J ~,rWt
<br /> S>hite American 'ED
<br /> r-_-:='.001 Elizabeth Rose Davis (Dec)
<br /> as uSL,u OI.EL nTti'+r vt it wit lrr ulr/,Y ~'atl+ ~r.a cwp ilr E't;:,,aE]y F'aC7l.iigr X15 fCA1CwIQM ISC'!c✓. Y~» 1.7" q'aWC
<br /> rr ay Ap. Q.rtiI:-rt•. + ke.'ne+'tary a r~-.,..TM 1 9 +71
<br /> ' Distributor Retail Tp )perware Sales 2 •inek'aOdtr's4 n
<br /> p iwT"fr,-"WjA Fpst ~+1:p. CAS7 r.Ep FASi , MIDDLE MA(pEAI SURNAME _ T
<br /> t
<br /> Fdg sir _ Burris _ I Gladis Jayne
<br /> C 1AS
<br /> ..NC.k;i~~, ~^~N ✓!-drr•A.1/.f.i-YAA,l,:
<br /> . e~ M.a ./kl .2a ~ a 3'n='A1a Y 5rmivs!
<br /> ies IT i942-1943 Garv Burris
<br /> ix p,r'f]t4dAt(1.-.~...,`_.•..~s~~4:i A:1!-C~C~tiT..... ~TPE:i 41N HAG `til CT7~'DiN TgWV STATf.:Pi
<br /> 2021 N. Sher:aan, Grand Island, \ebraska 68803
<br /> ra r y+.Ae4 ,IcaxrwaEa~ _w> ~:+.uEiwuoFC,aPC,~r.~n ,zlnoA(e z+r CFAeFrF.PrC>r'~~.C+tA%}+• HAi,,t
<br /> Ile
<br /> [](w.r.(Apr• 25, 2000 jWestlawn Memorial Park
<br /> a fU,ESUL -ow .r+.k.. v rZia CiFioMRV QH L+tE 4Ar~~,ar IOCA.Gw C. Tr.Aa llTrM 3?ATE
<br /> !Li_virigston-Sondermann F.H. Grand Island, Nebraska
<br /> ruNENAL kC4&f hX' E:3 iSTPZE T(yt A F p-A~ C11v QA, 0*,L STATE OPI
<br /> i
<br /> 601 N. Webb Road, Grand island, Nebraska 68803-4.050
<br /> ~j AW VIA 7; ,.Ltd( •••~.1•~-. 1ENTE flo-Y ONE C $E ;-k,F Lr F' R.) Z4.1 01 a r; V is
<br /> Fl i L
<br /> CyC ip Gam, ♦5 c,,. --:,V-6: MM77 :1 •~,.Y .••ti
<br /> 1
<br /> l:: "i `t y✓~raFtir.`•T ~.intiti~!'ti: A..yfrar. inrt •Gw:yo"e xU'twu rU rCy;,vp PA,~'TG F'FtA1.ti[}yA$T:,Er~w il. A•Jri:PSr f2~ was C,F.:t aEFEAiA_-o is vEir_.L...
<br /> N TeE PAS7 a 4CNT EXwaw:tw ()H Cfl:.r)r.ER'
<br /> r 7 F-1
<br /> -..v-.,--.~•.-~-- tVa%'95+~ Yr, 1_ y_.
<br /> r{ rt [f .YS-G • ' rAtc CIrI r. r f Yx ..}.1FV ✓~~_---•----r :Ya L,ESr3'+.3E ..FS.M ✓.1Vk• :('CNF:'+EJ n w
<br /> ''rlprtr • ry.rL,mww"/"a`"i.CCAm[X. TTf[T :rN ~iF O%, '_rlr Cj, TL)*1 ,
<br /> ?(1'A ~r ~.+~~+A..:. i ±xw ;,.n rE :.[inE~ +tu cdr r ix -wIE [•(7~rTr.
<br /> ~ f / r
<br /> 7-1 1 ~rC C ' E a ' _
<br /> i)1 J it oA, l sr-.f.o - Cv c:..• ; : rt :'n+c ac ~EAr„ Y xTlc NraDnt7vrC.Ea EEti• ran a _ W
<br /> r, y rr. 7'3c ~/YAIT.C.C:] DE wJ .r+
<br /> . j Ta ; a'Lf ii u. `e-w +Wc -P ^jk • rr *'x C ar. iG 1ryr ? A f Y a.aA.r~/r w n rwragayn ys rr, a'ky0n aCa✓•. xi.✓•✓o of
<br /> carha s. xaec (T' / ~ ; ~ y ® n r,lr are w pyre re.wn n s,r c✓✓eea; vArr
<br /> r~ 1 '"[vim((( (•t 1 ^ _ _ _ rt!.c:in r _
<br /> ::AC. Ti7SA,CC'd v$a'll'laTC7:Ir CDLATN' lea wtS CfGA+aC,+7i5wE i:1.ATICX, e,EFj: 7:a+SY.E C~ }Qp wAS CtlMr..E.ti`('r4 TE.7`
<br /> .-t~ J FS f ~f x] ~ WL>w.~ ~ ~ v'f5
<br /> ~1 ~Wr tiv9 .t-C CF.i'Y ~ .rv VSF.W~. -+F~aC rl ~ Prr 'SSXV ~ .~.tJUi'.Ty :`:tiY`^ ♦ :fir. r r;-[r Y- .
<br /> ?r. SiCti ~ C,~ ur `A.D. , 2116 t, Fa dle- A. I/TKI C u r Ur kGrand Island, NE 68803
<br /> ~ ~x ~A4 ~ ~ ~ ~w~. t ~ z ~T~ G1 ~ C a.7]~ • ESC~Br ~.°G.STMwN -b :fir
<br /> y ;f'G - APR 26 2000
<br />
|