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WAS ,7 ASE REFewo tO MEOICAI <br />PIIEGNAM.'.v W THE ar.ST 7 flM?NTMS' E><ALR'NER <br />m <br />CD <br />VD <br />G <br />916 oATEalwAY � a, :,, i 2x �auA�F »ia:,R, <br />,tee !NSC.R!9E MtMf M1aXTV �[.uRREO <br />� <br />-T1 <br />D <br />V <br />^� <br />CL. <br />STFEEI ;w uT p NO _ - _.+.�' "7M ri)WN STA!F <br />i 1 <br />TA OAYE CO DEAT" <br />i <br />WHEN TMS COPY CARFWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUM/ <br />SYSTE)K IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOMI <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISM'( in <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />DATE OF ISSUANCE�- N <br />DEC 2 2 2003 Aai3r <br />LINCOLN, NEBRASKA O HEALTH A)6 f N_ SE*w, <br />IN SERVICES <br />WILE jLE WITH <br />WHICH Is <br />STATE Of li8/tASxA- DBAt1)44NT OE FSALTH A MUld" SfstVIC!!S„l6wi& AA® Sf P01tT <br />VITAL STAYfS'i <br />u ❑ MpM,N <br />13 o; ouvowl <br />01 DOA <br />September 25, 1999 <br />OtNER C3 Nu1,.q tans <br />Qr- <br />rsauaIIana mi$er ittpp ! Josephine Louise Clp{l1er <br />fF t o-,-6O EA4A w v S ArAEEO fCWCEE� - �-�1:. REC OMS : Grand Is land Veterans Hare <br />v.+ r re auA d wTnw <br />Yss, b -0 %42 by 07-11 -45 _ Grand Lands ;\L 68803 <br />1� liON1AWf MAAJA,$ADDAESr !STM- 10AAF0 No •UtY <br />Burkett Station, Grand _Island, NE _6_8_803 <br />20 ff .![iNA L Nli q/ 211 NET�OROf i}SN/S�iC!1 :itC DATE - - - -'i jsG GEMETEPYI ON C:FIEAIAYOR� NAAjE <br />7 �Jev� [ �,,..,, Sept_. 19, 2999 Westlawn Memorial Park <br />1 fu,EAA► { Jiu fAAKTFFTV CMCREMATpRYl AT*h 01v ;tR TOWN STATE <br />Livingston— Sonde_rmann F.H. j �`""'" �`"°` Grand Island Nebraska <br />x196 FUN S [ ' , <br />Now AD- fSTNEET nAarn Nn MI T— .1 n... -- "•.. -..... -".. -.- _ _ - .._. <br />wwauw l,. t;.ntAA :ENTf*ONEYONEC."'iE -f-o EFQR a, bI AW is l; -_ <br />�W <br />`� w <br />r =; <br />C-' cn <br />o <br />24 -48 Hours <br />..- <br />n A oanE NLE' a= <br />}� <br />..-- _. -.._._ _ .,.._.�.___.._.__. <br />0 <br />Ae,.oe1 bAhA,n awl Am aAw1 <br />a SepS15 <br />DUf YO.OA AS A CONSEOVf NCE oT <br />� <br />rE- <br />T <br />1 KI <br />r,„h �N i , M'� " ►'R� M+' 1�N�F �1- r <br />of <br />P {Ftr ,r A f FAY4E WA5 THESE A i : a AVY'.w� r :! WAS ,7 ASE REFewo tO MEOICAI <br />PIIEGNAM.'.v W THE ar.ST 7 flM?NTMS' E><ALR'NER <br />m <br />CD <br />VD <br />pl C"'TA3NFH, <br />916 oATEalwAY � a, :,, i 2x �auA�F »ia:,R, <br />,tee !NSC.R!9E MtMf M1aXTV �[.uRREO <br />� <br />-T1 <br />D <br />V <br />^� <br />CL. <br />STFEEI ;w uT p NO _ - _.+.�' "7M ri)WN STA!F <br />i 1 <br />TA OAYE CO DEAT" <br />i ^!A OATF !%iF,SU <br />D <br />��. -�-� __.- •- .- '.."'." -"'-. <br />O..- <br />n <br />�,a ., <br />CD <br />(n <br />:> <br />::3 <br />c:j <br />uJ <br />� a <br />►—� <br />cn <br />CD <br />= <br />Ln <br />0 <br />fFk <br />rCD <br />Z <br />f7 <br />IN SERVICES <br />WILE jLE WITH <br />WHICH Is <br />STATE Of li8/tASxA- DBAt1)44NT OE FSALTH A MUld" SfstVIC!!S„l6wi& AA® Sf P01tT <br />VITAL STAYfS'i <br />u ❑ MpM,N <br />13 o; ouvowl <br />01 DOA <br />September 25, 1999 <br />OtNER C3 Nu1,.q tans <br />Qr- <br />rsauaIIana mi$er ittpp ! Josephine Louise Clp{l1er <br />fF t o-,-6O EA4A w v S ArAEEO fCWCEE� - �-�1:. REC OMS : Grand Is land Veterans Hare <br />v.+ r re auA d wTnw <br />Yss, b -0 %42 by 07-11 -45 _ Grand Lands ;\L 68803 <br />1� liON1AWf MAAJA,$ADDAESr !STM- 10AAF0 No •UtY <br />Burkett Station, Grand _Island, NE _6_8_803 <br />20 ff .![iNA L Nli q/ 211 NET�OROf i}SN/S�iC!1 :itC DATE - - - -'i jsG GEMETEPYI ON C:FIEAIAYOR� NAAjE <br />7 �Jev� [ �,,..,, Sept_. 19, 2999 Westlawn Memorial Park <br />1 fu,EAA► { Jiu fAAKTFFTV CMCREMATpRYl AT*h 01v ;tR TOWN STATE <br />Livingston— Sonde_rmann F.H. j �`""'" �`"°` Grand Island Nebraska <br />x196 FUN S [ ' , <br />Now AD- fSTNEET nAarn Nn MI T— .1 n... -- "•.. -..... -".. -.- _ _ - .._. <br />wwauw l,. t;.ntAA :ENTf*ONEYONEC."'iE -f-o EFQR a, bI AW is l; -_ <br />�W <br />`� w <br />MfM�vA76MM!'W19nM Yq dldtA <br />rardiorespiratory Failure <br />-- ..- <br />24 -48 Hours <br />..- <br />n A oanE NLE' a= <br />}� <br />..-- _. -.._._ _ .,.._.�.___.._.__. <br />-�-.. � _ . <br />Ae,.oe1 bAhA,n awl Am aAw1 <br />a SepS15 <br />DUf YO.OA AS A CONSEOVf NCE oT <br />r1a�,r be-W o1w1 •uN• <br />1 KI <br />r,„h �N i , M'� " ►'R� M+' 1�N�F �1- r <br />of <br />P {Ftr ,r A f FAY4E WA5 THESE A i : a AVY'.w� r :! WAS ,7 ASE REFewo tO MEOICAI <br />PIIEGNAM.'.v W THE ar.ST 7 flM?NTMS' E><ALR'NER <br />bladder, Hvperlipidemia. <br />Se; YAA 1 -1Mi <br />i <br />pl C"'TA3NFH, <br />916 oATEalwAY � a, :,, i 2x �auA�F »ia:,R, <br />,tee !NSC.R!9E MtMf M1aXTV �[.uRREO <br />- <br />� <br />L.J }'=d LJ n,rOvq i' no NAAV AT W001A -Ttl1 VLaCEtQF M.A,RY .• �ICMm, 4r <br />i 9rrN aAer'iY we �ownM' <br />R, rss� ycprY i A`-a IOCATiDN ~ <br />STFEEI ;w uT p NO _ - _.+.�' "7M ri)WN STA!F <br />i 1 <br />TA OAYE CO DEAT" <br />i ^!A OATF !%iF,SU <br />- 'r- <br />��. -�-� __.- •- .- '.."'." -"'-. <br />6 <br />f Ls�9�?'.- _.z5,1999 _ <br />i 124 iNYE iFtl1f0 •W [Lr, r.. 11c '09 OF DEATN �.' 2!c c'NQF X0)CE60EAC1 .W, FJ1r y. I2E0 F'RONO <br />$ePtemb�r 29. 1999 4: 25 P._ - -- <br />j <br />h G ,1 1w W VW* W OW b Mt •u~YI,O Q+�o.al. <br />UTAMI. ac�r•WY <br />Arc t„r r _ <br />�.zo35 T(JiWCO;W C0#4?AW1E TO. THE jXASTW 308;;wS F16A7�ORTTSwf OONAMN KENCONW.. Fil, T bib WASCgISikT GRANIe <br />i N YES LJ w L7 —L— 0 IFS IM NO I � YES <br />51 "AW AND AODFES3 Q0 CEA761EA ^41510M C OVER 5"SKSANOR COUNTY ATTCHNF. , T - _ <br />r K.1,p RrR: <br />M.A. Tompkins, N.D., Grand Island Veterans Hnmp_ ArAnA TclnnY4 err coono <br />