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<br />W11EN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF 11EALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY.
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS. i►
<br />DATE OF ISSUANCE
<br />Qw 19 No STANLEY S. CQOPaR, DIRECTOR
<br />LINCOLN. NEBRASKA BUREAU OF VITAL STATISTICS
<br />STATE OF NEBRASKA — OE}ARTYEHT OF HEALTH
<br />§URE,AU OF WAL STATl8M
<br />CERTIFICATE OF DEATH
<br />1 O CEOENT. NAME PAST MDR! LIST
<br />Starry Frederick Brengelman
<br />A CITY AND STATE OF BWTN IRNIP USA wA•,y(pyN7.• 5A AOE L1Y BuraA7
<br />r.., .b 409 DAYS
<br />Bwne county, Nebraska 69
<br />7 SEX 3 LWE OF MArn Mw" M •w,
<br />dale . November 3, 1990
<br />6 DATE OF WAIN MGM OJV YwI
<br />St NOUa5 MJaS
<br />March L5, 1901
<br />7 SOCIAL SECVWTV NUMBER Oi F1AGE OF DEAM NOS•ITAL y rlmw. ; ER 0000" DOA
<br />498 -30 -4755 �i
<br />OTNiR a»Y.mm'o 4R6074.46 o.U, ,I
<br />6p FAC4ArT -Nft•, IN wa1.MA0.fdw. JO�AIy,••,IFgye
<br />6C otr TOWN OR LOCH 0%OF DEATH 001N90E �M�Y'hJS BA. COUNTY OF OEATN
<br />Home: 1315 S. Lincoln
<br />Grand Island ? loll
<br />S�/a e m aJd'iTT
<br />hilt :'n TOWN 0ILOGLrCW iC sriiEE"M. NUMBER ,KaOIV ' }71A' `�'. �c Y"0,
<br />tiTi2�;r iii alL
<br />Grand island ; 13L5 S. Lincoln
<br />NtM1eQnNs+Metv'aAmrican 1•^ JIIW
<br />Y:*3AAM ;6.. .i O s7 � •3 NAMEOFSOUSE
<br />C 1k'.Q RP W S' Yk•tiM •,rE :qw* -
<br />3,N3V -.
<br />loon" arYrd Rose Christensen
<br />�
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<br />•'v -QF tusltlE.�gma.s*�• .:lL.cATVr s wan, Naeerca7iL
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<br />FATHER • NA1E FIRST I(�T�� - I.A S 17 MOTHER • Uh"% NAME
<br />Henry -- Brengelman
<br />Anna -- Meyer
<br />[It,
<br />WAS DECEASED EVER W U O ANTED FORCES, 19 WFORMAN /- NAME•W1tW0 AOLVMSS
<br />gTAEET O11RF0 MO.CITT OR IOM%et ifait ilFl
<br />"),jo " ' an.aose Brengelman -1315 S.
<br />Lincoln -Grand Island, NE.
<br />, BUI,IIL Cr,nlrpl11MA0UA 200 pATE 70e CEMETERV OR CREMATORV • NAME
<br />1700 LM.10N CITY OR TOWN 9T6iE
<br />vial Nov. 61 19 9,0 WestlaWn Memorial Park
<br />' Grand Island) NE.
<br />/T
<br />r E MER . TURE B LIf.EN7/�IO �-I 3 E! !� FUNEMI NOME N41E ANO ADORE55
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<br />/// fel- Butler- Geddes 1123 W. 2nd, Grand Island, NE.68801
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<br />CUpENT.SMN•AE 110,IIC/OE. -r.
<br />� DATE Rb.0117 711 26C HOUR OF,UURV 260 pESCtOEE HOW OyURVOCCURTEO
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<br />261 P: A'E OF FLAlt1V - N IIOwIA twm MNL dcVV
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<br />2TA DATE OF DEATH ;ib 011' n1
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