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' t t•-ca -yy 80 I i = D i 3une 9, 1919 7 SOC34 SECURTTY NUMBER 5413 -01 -3961 N. PLACE OF DEATH !+±u ❑ ❑ ER O+ M ❑ DOA OTHER ��, 1: H�.e ❑ Ansoonce ❑ °"� /�°" " - - - -� ft FdGS.IR' -Nelat McPf+'tl1{i►dt pYY,IIMIJIIr /APOaI Tiffany mare Care Centex k C. rY TOM ON OO T_10e1 OF MATH n T INSIDE CRY LIMITS I CA i29 wand Island Yee ® 7b ❑ Hall z C _ rn o Z rn D c � = � M o LZ UN T1 eq r co = _� r- C=) r-h - u ~ � CD co C-n Ca z WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD: CW F_ILE WITH THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA TISTIC1 SECTIbk WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. A DATE OF ISSUANCE ANLEYS. COOPER AUG 1 3 2004 200410175 ASSMrANT STA=TE.AE&ISTRAR LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM STATE OI:IEBLASXA DBlAltIMM OF iLAL7H AND IUMM SMtVKU FDLANCBAND SU"I*(T� 'VTrAL STATISM == S" J -- 1 3 5 8 8 CERTIFICATE OF MATH I DECEMWT -- tLJ� FIRST MODLE LAST 2 StY 3 MATE OF MET," 1w in :Vir Y6.erl Helen NM Detweiler Female November 22, 1999 a CITY AND STATE OF O RTH AT #W V VSA. RMU COIrMyI Se AGE • LW BAO" UNDER 1 YEAR FINDER 1 DAY t WE :3F BWTH 7AADF* Ow Yeri IYM 5b MOS DAYS 5C. W)URS ►ANTS York, Nebraska t t•-ca -yy 80 I i z7b1 DATE SIGNED (AID ZPAY Y, J _ i 3une 9, 1919 7 SOC34 SECURTTY NUMBER 5413 -01 -3961 N. PLACE OF DEATH !+±u ❑ ❑ ER O+ M ❑ DOA OTHER ��, 1: H�.e ❑ Ansoonce ❑ °"� /�°" " - - - -� ft FdGS.IR' -Nelat McPf+'tl1{i►dt pYY,IIMIJIIr /APOaI Tiffany mare Care Centex k C. rY TOM ON OO T_10e1 OF MATH !b INSIDE CRY LIMITS I N COUNTY of DEATH i29 wand Island Yee ® 7b ❑ Hall Nebraska i Hall Grand Island ! 547 E. Capital 68801, 10 ^ACE - ;e y."%*OMCa AnMrrMx irpn 7F _ANCESTRY Ilg- IMfal. Mental. Dermal. Sri 112 t (O MARKED ;"" J ME MOWED 13 NAOFSPOUSE ;Mwk O++wMV� wap — .t i sw*I White , DWI American la DER OIYORCEU i DOMId Detweiler EDU CAtN +4 USUALOGCUPATON KD OF WSNESS INDUSTRY 5 01fluQ06;70 Domestic M 12 SIASaDiaAlhav :: +r�0r'+r2W5 �I�' =� � � �• , _ IfFATIH1- NAME "45T MOW � LAST -- 17 MOTHER FIRST A6bOt E MAIDEN SUi11AeIE -^ Henry Schnelder Molly tlnknow>n IS WAS DECEASED EVER k US AMAEO FOFKX57 - -TIP* WFOMWMT -NAME iTVA�pwle+l av"9"e am own ofarrow j Donald Detweiler - - -- 547 E. Capital, Grand Island, NE 68801 20 DA30AVP - "NATURf 1 MO 21* WYMOD OF 000SITw7+ 121b DATE 12% Cc'METEW3RCAEMA1:,*T tvAa/i Nov. 26, 1999; Grand island Cemetery 22i, F ME 72111 CEMETEPY Oi4 CAEMAVC*N LXATI. -A ClT'+ T'VVN cTAIE Apfel•- Butler s 117Ne DO.. Grand Island, Nebraska rm FUNERAL HOME ADDRESS ISTREET OR RFD NO Cm OR TOWN. STATE. HPI 1123 West Second, Grand Island.. NE 23 vYM1ED1/1 CAUSE (ENTER ONLY ONE CAI PART I WI 1. S� i M PART L M DATE of N,NJRY (Ab Dry vel At 10MM Cj UnWWM MO U SWK% C] PWO% No KWRY AT WORK w Q Hanaf bvMgYC° YMe ❑ No ❑ . IN,K1RY P LINE FOR a V AND rG: t t•-ca -yy �MVM•yrM_baw� z7b1 DATE SIGNED (AID ZPAY Y, J 27C TIME 17��_ ° 2711. Tb the b7a d my a�MIM. ps.•de� ac�✓ra1 M PART M IF cENALE WAS T£g 1 --- CYANI81 aMe11. [ � / ISIxaaA ad TMeI ► PREGNANCY IN TKE PAST "MONTHS' (WJ TOBAC7..D USE CONTRIBUTE TO THE TH7 i29 YES ❑ NO ❑ UNKNOWN IN,K1RY P LINE FOR a V AND rG: Pw`a aw oe M �MVM•yrM_baw� PART M IF cENALE WAS T£g 1 --- lA A�l!O►S —' ?5 WA SF 40 EiWED TO MEDICAL PREGNANCY IN TKE PAST "MONTHS' Ex R OR CMD!r R" AYef IL -54 YyA r-1 M , ✓ •e: t �_ r_ I i Ytl N° 7 �ESGRIBE H3W ri.IL)AN a':0rWE0 Aec*y/.Wm reva tApDy xA _•KA:IDM1 Sl'AEET OR PFD NO _,T +3R TIVAN STATF -- s I A. DATE SrIULD W D1, t., " — 1 Wb TIME OF fZOl -- i r I $ 'sec �ED DEAD AN LMV '", 2911 °g0N0JNCE3 LEAD ,T+trw, s a 1 M b rr 1 2% Cn vIe Uwe b e.tTCr+Mwr• .i,o a eMMegalon. n m. OD•nr, Ued eceumW a •., Nre t.me LIMB aW Plete AM QR x ele CM14ef51 ttlle11 — —_ �e a.11 Tavel ► GAN OR TISSUE DONATION BEEN CONSWEDED', 30L WAS C,3NSEKT 1.,AANTEDI YES W-1 YES NO ITY ATTORNEY I I rVA0 21 PnMI FLED BY REGISTRAR /W VAS vi I MC 2 i9 69.