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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT`CERTIFIES THE BELOW TO BG.A TRn -COPY' <br />OF AN ORIGi A3. RECORD ON FILE WITH THE STATE D?$�ki6'f'0p ; HLALTH <br />BUREAU OF VITAL STATISTICS, WHICH ,IS THA LEOMM-'0806SITORItIOR <br />VITAL RECORDS. ,s ' <br />DATE OF ISSUANCE _ <br />' AUG 18 1989 . ' .., , ;, ••. ; �.•.: ' - ;� :,.. <br />STANLEY :S.. PM,- AtR�CT�3R <br />LINCOLN, NEBRASKA BUREAU OF 'VITAL-,:".$TOiSTICS <br />STATE Of 1OMMfA O@A1 TMW OF MULTN 89 -104 75 T <br />UMMOPMAUSTATIiMS <br />CF. MROATE OFL?EATH F-�/ j <br />:t. OIL'faw <br />fT.MAEtf FfKT WOES ,EA7( :• `..:-;::.:• <br />tBFx J.t ?M� iDEI1TM IfNnftOiXrEaoJ <br />Flossie Arlene ,Fier <br />1 <br />it Nd0 TA OfEfNTM <br />$a AGE •Lima f", ' ' <br />M CITEOF EfRM f ,C.'Jq:YYj <br />SC - '.Ef75 <br />r <br />Polk Neb aslca <br />1Yet) S.% DAYS <br />55 '; <br />jX1113t 2- 1914 <br />1r foaM, ., fa PIACEOfOEArM . <br />.. <br />r .; ' ' , ► yk R1 ""me Ci Chi 04"m C WA <br />+ SQ6wr3$ -gig 3Li :'-' OTNFR es Mn N.M. o ammme o ESA. rsx[ <br />ML fAmLavlawme +/ s"Mam[t'/mmewAasfwl <br />ft CJTY. TOM OR EOCAT*N Of DEATM ft IN CMLWMRS <br />N.000MMOFMATM - <br />fSDao,y r «orAy <br />Yes <br />Dou las ; <br />�• - aTATE <br />t Cows <br />fe. CRr. TOMM 011 tOP.ATION <br />ft Emil Mlo MAMYEA mwiwwZO Crr► <br />fa ffiDE EsaN I.Yfr6 <br />Nebraska '° <br />Polk <br />Poi <br />fsa+tefyraibMM► <br />tC w4E --"&wm flllgs 4tta♦IMMfI�t <br />- "a ! <br />r,. Amc"m wo^i t&%MG .Gw�wErc1 <br />nr.LyYl <br />tz uACwIE )WM MOM <br />WOMED.OIVOQ6EQ Rime " <br />13 Oi SIPM5E dwtA iwmaaAtAay <br />. <br />.*4 <br />to <br />American ; � <br />,: adman <br />fa ATEJMM iraft OW *I wn Mw MArawo <br />tfd M wOF toO Ar71Y <br />rafMrrfYttArM/Orr1M� <br />EwMwfErywiAgiawfpN) I c"W11•405•1 <br />Bookkee er <br />AgrIcu t <br />l <br />tt pTMg1 •MME fMST POOLE EA[T IF MOTHER • MMOEM M MFE mw • . POOLE LA.S! <br />Orlie V n0 Vigla G bert - <br />ifl WAS ff-vnewww"namm"a Yi AIWD fO110E,7 :? I.'K .NAME • —.,NO AOOMESS I D. . CIT OR TO1NM. STATE• 2f%, <br />Iris« «dcl <br />No <br />um <br />70a MMML CI <br />aMlr•M <br />2f► OAT[ <br />2ft CIMETIM OA CRHgTOAY ft 2Ql LOCAT CRY 011 TOW" STATE <br />B <br />r <br />,Ummbu f{NIEM► MO1� . %W= (5T11EET OR RfA M0. CRY OAT ATE 21n <br />[I. 11rAl lrtl • fl➢NAIDIff A EfXM1[ M4 <br />�yyG <br />Heafey- Reafey Hoffmann- Dworak b Cutler, 7805 West <br />27. TI CAM OMKr OHE <br />►[M1 + it's AND ILD , nMMYr eMMw W tf1r1 <br />70. on E , wMate alMt WWI mm <br />1 <br />:7UE TO.OA A OF • i <br />"Mow <br />I <br />1 <br />/ OTMp1 [IDII rmff C0010fMa • D/M"I,r arlfftubr a Ow ,%x too" JR4,111, W 'd: f W" DIE A IN <br />AUTOISY <br />25 WASCAMWEAK070MEDOW <br />[ opus. it'co ft TIE /AiT f r <br />f4svfy w of NO/ <br />oMI CO1fDNElfr <br />• YIAO w <br />NO <br />. <br />2M LIMOET. <br />DII. /RMLOrw t10M R/rM <br />[w GATE Oi mnw 01ax ; Yr/ <br />MAM1r M DESC NEAOA'Y GUMMED <br />ftA~T tym <br />m RACE Of • rwf M Flow "m rim . NO Low*m [TREET OR 11 iD N0 cm OR TOM# <br />rfy..r+. fair . <br />.. <br />]a1t. O[A ffM,Obl /J <br />2fra DATEEIONED JW.Wn1 210 <br />TIME Of O= -ATM <br />Y <br />f!S <br />. <br />JIM QyYy <br />vJ 71. L5 toy <br />1050 <br />2//0NMWWMAD lw1.Q7%Oj <br />RMWOOMD (Mlrr) <br />a <br />�d <br />va rM AMone&0AgIDEN <br />rM ME1Wi <br />L- 10 atuo.fm <br />Eb YM. YM Mf M&O W4 AY 10 ra ca"m LIfMI <br />aMT ► <br />vwToo 0 <br />[ bcE� /6/1000DUMOOMTMYI�TOt+EOEArM. <br />2oa N+1�0AiAMEM�R 911�1[odM71OMr/EOICCMIIOEfEDr >a <br />WASCOMLEERGRAMTED? <br />­o t" O MO <br />O YEi NO <br />d vEf �NO <br />a+ of ,-==fO w cDAONE s ftffr N a c5vwv xno11NET)Crao. d "m <br />Z1 <br />©f <br />J t v <br />• M DATE CXdV E0:54 <br />`, <br />/[�� <br />1589Dry. <br />L�7il�,A <br />\ �Jl <br />I <br />ir' • <br />J <br />J <br />