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(STATE OF TENNESSEE) <br />CERTIFICATION OF VITAL RECORD -- \ <br />1. Df4gdinTs Legal Name. <br />KATHERINE ANN MAURER-HILKER <br />NUR$$N ,MOMF„iJ.;ONQ TER <br />to. Surviving Spouse (neme'iiib'rto first mmrtbpi) <br />T. <br />GRAND ISLAND. NE <br />:t1a. Doe deli** U$usi <br />HOMEMAKER <br />W:2O25::O0239O _..:._.... / <br />13e,.112tdr _L pc4 <br />J! YSocads�ttil} HIilponit -Drlgin? <br />NatOANISFNHISPAi1A0 P`i7N0 <br />aleiiiaa*Addiiiiq,MFlrtaraC:N. . •....�� .:::...::.... <br />:CREST .AWN FUNERAL ROMEN CREti+lATION CENT' 2-Sao WEST JIFICKSON ST; <br />26. CMHIir � <br />2Ee PHYSICIAN TO THE BEST SAY' KNOWLEDGE DEATH OCCURRED AT TH , TIME, AND:PLACE AI <br />26b. E EMEDICAL EXAMINER ON T�SASS OF EXAMINATION,. $!1D/OR INVESTN( itJf# IN MY OPINION, DEATa <br />'WE 14'trE cAUSEis§ANDNANa SIA. <br />2L Pan I. ENTER THE CHAIN OF EVENTS (DISEASES ft <br />. SUCH AS CARDIAC ARREST. RESPIRATORY ARREST. <br />DAMEOIATE: <br />MAI dyaaae Wr.:i:( <br />toad)*ai+s,ulWigih <br />dash). Bepu�Ni�lfy <br />FY ocrdltioniAiny. <br />ieedsiQ.te:tlia:rivas <br />Vow ersihua. Enwr w <br />UNOEIR:Yi n CADGE <br />(disease or nt.ry Nat <br />(ndlerd the events <br />'tANJMMQ k dean)1ASL: <br />c i3EP. • `:1MFARCTION:::: <br />Partlit'.C1fiEk VOW, <br />• <br />FV <br />25a. Wes an Autopsy Performed? <br />31.Did-tebeoeoUsir:Saetdibet lal'DastHr:':: <br />UNKNOWN <br />this is a true and coned-representa t rsn of tiie;:ia gir it tat ; on 1 <br />it Records. This copy is not valid unless prepared on securiiy::paperld <br />x:uiitate ttegirr. <br />dward`G Bishrop <br />State Registrar <br />e'4kXsEls A +'w*a4./to4Sas++neAY'Y'YY�41'Yll:At'b�4.t�.14'f talYµe.l..1Gu1+ +'et'uyai ++r fltM4fls13Y'1,'a.il+•ru4gLLL.4sss3'at'JA�:>L'YY&A'L'1.�Ma. <br />ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE <br />lt <br />