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<br />STATE OF NEBRASKA y
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<br />0000 .�.. o ve=. as .:•cvF ..•7•.+-,..�dYIEY ..v.....6� x...g,..,,.,
<br />WHEN HIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT
<br />CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD
<br />ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />6/4/2021
<br />LINCOLN, NEBRASKA
<br />1 DEOCOAN T • NAME
<br />202106048
<br />Sarak Bohnenkamp
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATS OFNEIPRASRA- DEpArrmea OF MALIN MD HUMAN names FD ANGBMD SUPPORT
<br />VITAL irrAT1i11C5
<br />CERTIFICATE OF DEATH
<br />03 02174
<br />FIRST NOOSE LAST
<br />William
<br />F CRYAMD STATE OFD 35I ONO LISA nom
<br />t'dt ro,
<br />YRk"SOCIAL sic AMY MAEER
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<br />Tiffany Square
<br />a
<br />a '/►Care Center
<br />„NT*
<br />rE90H10E STATEIsla1d505-22-7714 CONTY.01.40AgoYIWrNW
<br />040020Ne3raBka
<br />Grand Nebraska Hall
<br />Edwin
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<br />" White
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<br />7
<br />UtYOER t YEAR
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<br />M!.
<br />WADER 1 DAY
<br />3 DATE OF DEATH
<br />!R NOS • DAYS
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<br />NDUPS
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<br />M COUNT OF DEATH
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<br />L�7a'p1
<br />141 BTRE TAND TENGER A..m ZiCoAM f 5. *NOECTTSmina
<br />Grand Island 13119 W. Faidley, 68803 1 Ya .00U
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<br />T1.. Ml1RMU\MT:. .N .Jt6 MOMS +STREET ORRFO NO.CRY OA TOWN STATE LPI
<br />4005 Iv Ave.. Grand Island, Nebraska 68803
<br />ETiALa�L•
<br />TWEE IiCBiEIIO ala ININCDOF OSPOSITICN210 DAIS 2Tc CONFER.. ORCROAATORY NAME
<br />=
<br />.y / 037 I . ❑ .tea I
<br />1 Feb. 21. 20031 Elmwood Cemetery
<br />TIA CEMETERY OR CREwtORT LOCATION• C,.0* TORN
<br />F:IMAl a'T6' Piln'r 31 Win U"NW 1 a °"�0' 1 St _ Paul. Hebrask
<br />uMi11M1111DMF A00/ SS 7 STREET oR NFA NO., CRY 0R T37.100 STATE. m1
<br />1 or:. ❑ DN1RCE1 Ruth Irene Krenlacek
<br />tb MD OF 6U6*SS INDUSTRY
<br />Gas Trucks
<br />t 7. MOt3IRi
<br />Milier
<br />1 Ruth Irene Miller
<br />115 EDUCATION 150.0,,N3 PEPM V•N• a.n.FFhq
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<br />FRST WOOLS
<br />UM06 1
<br />2i a Amanda Wilcox
<br />3213 W. North Front Street. Grand Island, Nebraska 68803
<br />t.aeT...e CAUSE
<br />TENTER O.EY ONE t*ME ,A1 >a AND AN
<br />PART
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<br />0 YES N0 UMNNOR/
<br />DT NAME ANQ ACOORESE OF CEIFIMER 1P0,YEICIAN CONONER 5 PMYSWIAN OR COUMIY ArT0*NEYI
<br />Cary L. 'Sett] e, M.D. 2116 . Faicll A
<br />32. REGISNAR
<br />it7
<br />2* TIME OF (EAT.
<br />C. TY OR TORN ..: 5`TA:T.
<br />:As DAZE SIGNED AA• 0c. >-. 1 ]E. 11ME OF DEA7N
<br />2ec 00O4000CE0 MAO ...• qn mp PRONDUNCEU MAO IMa,h
<br />liqc
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<br />I5.."*., are TAW IL
<br />ORGAN OR TISSUE DONATION SEEN CDNSIOEREO' 1 jl YYAS CONSENT WANTED',
<br />rc5 NO ❑ TEs ;RINO
<br />, Ste #400, Grand Island, NE 68803
<br />32e DATE FILED OT REGISTRAR IAS. D...1
<br />FEB 2 7 2003
<br />
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