, „ . � ;�_ -
<br /> . i('� �—,r,.,.
<br /> � � -+ .�Cr��.� � . , -..�.. .
<br /> -.� . . - • � ., . � . . . , . _��a
<br /> -y���RN ' ',n,,.
<br /> .� �z .-1 ..�� M4 T / � ..'Yl... _
<br /> ��f:Y/"nt��rt1�. � . �Y'-��. . . t./� ' . 'j��.[�... .��t't �
<br /> . • . . _ . . ,. . . . . .. l . � � 1 _" '� .re�t..
<br /> .. ' . ` ��
<br /> .. �' .. .. •/.
<br /> t ����
<br /> ..�
<br /> . .' , . . .. . .. �� .. _--
<br /> .. ".. . . .. '.�"_"_"'�"...��'�._ ,.
<br /> __"_'_...�.._.._....... .. ..__.'_"...:.._.�.._'"_"__"___"......_............_....._.�7_J...r...�...._.�..._.-.._._. .—_.—._..._'""__'__`.._............. a..... .
<br /> � S4ATF Of NL�RASIfA—DEIARTMElIT OF HEALTN � � �
<br /> ' ' • ��`/�M �UIILAU�i YITRI STATISTICS �
<br /> , � �� ����� G��TIFl�AT�0���d!Tb1; ,. , ., �4��P� � �-��
<br /> - . - � 1��—�� Ifi+'L- D !O�D A N �eo..Oo�,Yr.) � ,.��
<br /> • • � .
<br /> . - • 1 �' Q �i914 �.11� lL$�l1t�4� � 19$� •• n
<br /> �� MAC -U���. 14, ot,A�pk�n O�IO�N/OISClNI(�.p,trollan,M�dton, A61-1a��1�wMq ,UNOt�1 YlAR UNOt� AY,DA7[0I{I�IN(Mo.,Do�.Yr.J _ �
<br /> - ' In�i�n,�wJ idtKil�► O��M�.�k.If�/�Nf�) (Yn) MOf. � PAYS MOU�7� IAINS �
<br /> , �. �L• Q�fl �'�' ea� ee`__ �_� � �1��.���
<br /> � e+o i�ifo DTlIII�I/�n�r�sUlA., CIII[lNO/WHAICUUNTIIY ■ IlD,NIVtR1MtRI�D, NMIfOIS►OUSlplvl�,or..�ora.�.o..i �1 ;
<br /> �ow�s��n�r 1 wi0pwtb.DnOl1tlDfSr.��/�l '""""�
<br /> � .. Ha;L�.ae aeka 4. . u. �n�.�t3ae— � +w,•
<br /> . fOC1Ai0l'Ut1IYH M�[� USUAIOCCU/ATIONfOti�ll� �lN�1lon�durle��etl KINDO/�USINISSOIIINOUSi�Y CQUN O�OIAiN �','�
<br /> dn�llnp Gfn.����i/nliqd) ,q�
<br /> ��•-�7-32.�682 �ae. C ub. R tae�ruit �.a .
<br /> - Cltr.tOWNQ11lUCAYIONOiDlAtN INSIOlCIiYLIMli3 NO!►ItA10�O1HEAINSTITU110N-Naw�(II,n�Inii�Mb U��of►o1�Nlt i.I�<.�•o0a. ,+,•,_ •r�yi
<br /> � (SPkfl 11orNo) p7w I�Nandnr b�q a�i��1�•4t�v tw.l•��Mn�liya�ry) ` .. � .
<br /> . ,e �+� NAl�'uka �k. �O ua.FL;NO Wi�ee sTAd� oP Itte� 11 ��.. � • e.
<br /> `�I'"' ��.
<br /> �� IIESIDl17CN-bTAt1 COUNT/ ^ CItY,YOWN QII IOCATtON STREFt ANO NUM�CII INSID2 CIT1f llMlii ��
<br /> (SPrdf YqorNel '; ��.
<br /> . . u.. Nsb�'aelca �se. HdKal�d u�. Elbe► ua Bmt 61.J1 R.R. �n.��jo_ �=.__ ,
<br /> ' t - Il 00l! US1 MOfHEN-MAIDINNAM! �IRSi iDDI! SI ' � '�� �- .��i;;
<br /> p �..
<br /> , Frank Yonker deo� M�b7,� Niokaraon . ,:,�...:�+'��
<br /> ' � WAS OEC[ASlO N!�IN U.l.ARMfD lORClSf IN►ORMANT-NMl!-RlLAIIONjNU-MAllIN6 AOO�Ib3 tu�eu o���n No.cm o�rowN.srere.tih
<br /> - R•4.�i..►� �n�n.o�w.u,e.a anu�a n..+u�
<br /> 1�. �� w. II�►i E. WiLe.� aba_�i .E9L6L-+�_ELbt�..N�r. „°•.Y:.R.'r.� j
<br /> W IIUI,G�evatl0n.Renorol UA1 CEMlif11Y OII CtIMATOIIY-NAMi IOCAbOH GIiY 011 i0 SiAI! :.y�„ .
<br /> ,o,. Bttrial ?e. Jtt7y 16 1 a. Xntikes Hi]]. C _ou.�et :oa. �al�aeks , -�'.;� �
<br /> M 11 LII- (OfJA E� C(NSI NO. •1��'�� �UN!Al NOMI-NAMF ANOAOOAISS Iti�ll/O��i O NO.C�r OI IOWN. IAt�,t111
<br /> IJr ' ! ,� ,
<br /> � ,�. • ,,.Jaoobee�n Fwae�al Hase �i11 ��0'� St. PA �r. 68873 .` ' ;;`�„,t.�,,,:�►°
<br /> . � Ai!O�0[AiH�Me, �,Yr.) DA 6 U(Mo. a�,Y• OUII ► ! i �"� - �
<br /> .. l i ���� - •:'�13�{ai�c.==,'
<br /> ��:.,��m._...
<br /> �7a. p 7�a7"1.8-83 ��e. 10:3C a M � -. c � ��.
<br /> -, � T I NEDI o., o/, ..1 HOUIOl6t iN 1{ C �RONOUNClDOlAO �RONOUHClDO4A0(Hovd + ' �
<br /> _ _. _._ � .. .__ j 'S r.�Ti flNa..Dor.Yrl �• ' _—
<br /> , s 27s. 7]a �► '���'t - .3- ` .�c M Ti� '_� _
<br /> , ,'. ,� uw��6)wM�bw�N�e���a��M u�M�I.r./ot�e.d ol����.1 b�a�M J�V Oe M�►a�4 d�uaie�tlen�+dlu 7�w�N��n�n.1�q�pi�N����iA�nnd w ' . �y+�A
<br /> �b nq.do4�n��Iw��n�Iv�N w�WA�roqi �i �
<br /> 0 d.11i��.n..1 t7�li!� v= y•�
<br /> 21�.tlrpn�r.n an/f��bl� • 1.[ _
<br /> , � � !AND ES CL�I 1 R(►NTS CIAN,CORONl�' ►NY CI N O�COUNIY AiIORNlT)(f�p�or hinlJ / ' /� .�/' ! -
<br /> � , "� . � ✓��Y' (�'� Q'L'G�Uf :11
<br /> V G ; r
<br /> • - E6I3TRM • . OAi!�EtE1vfD P!RE6 iRA (Mo.,Oo�,Yr.J � � +
<br /> i � `
<br /> ZN.li�w�h�d� • � ����t.. �'''\ � ��C..�t S6b �/' r� ��.� V 1G., � •.
<br /> ! fI t R ONIY ON!CAUSi/tll UN[IO�fol,f /.kND ftll , IeNnd MMw�n�H�•i M�!� �
<br /> �1�T � ..
<br /> , "'au[.ta�� C s��d land nPCk krauma None :�
<br /> , 1a. � �.a�.i r�..»�.�...ti.w . `"-.'r �
<br /> � ,��. .i
<br /> ��� traf£ic ac,cide�C �
<br /> ,� 0 !10.OII A!A CONSfOUfMCI Oh � �.wm MM rwt�w��q1�
<br /> ,t,
<br /> Id ' ���
<br /> �A��1{�(r({NIfICAHI tOM01110Nt- T�ii�n�op�rUNty�r/�m►►r1.H�N��N ►AII III.1/1lYAll WAs N!p AVI01►1 WAt LAtl qlti�t0 f0 Ylp l . �ly `
<br /> „ /[/Ot1�M;11Ntu��A�f�IAOH�NSt ftlkd�����N�1 1[AA�Vf�NU W COWI/t� � ,.
<br /> • �• U� U N1X� �e. No 1O YEEB�r�+.1 �� ,. . , A`i
<br /> •CC�OINT,{OICIy{,IFWYGI UNp��, pAfl O�IN1U�r(Mw.D��,M1.� NOU�M�N1U►t DISCtl�(NpW INIUtf OCWI�lO ' �
<br /> - M IIMDNq NlVtffl0AT10lL HMtif�l �i.
<br /> �a. �ae. _ oa. r �aa.
<br /> traffic accident 1
<br /> � r wt wrir / C INJU�l� 1 r.u�.�iN�. sa�ry. qN {l�f�f O�11 0 N� CII'/W IOWN �I�tl � �J I'i
<br /> t4«W r..�w.� d�N��dN;q.u..rir.dyi
<br /> lVO ,o,. Cdunt road , . Elba I�E �"': �
<br />. �, � �j
<br /> � ... .. _ ---- -— � • - --� - I 1�. t �(�
<br /> , � • R�i
<br />_ � a
<br /> � , � WEIEN TgIS COpY CARRIES THE RAISED SEAL OF TIiL NEBRASKA � ��;
<br /> - � ', � STATE DEPARTMENT OI' HL�ALTH� IT CBtiTIrIES T1iE ABOYE TO BE ; �
<br /> A TRUE COPY OF AN ORYGINAL RECORD ON FILB WITfl THG STAT� � ��
<br /> ' � '. � D�PARTMEN� OF �iEALTH� BUREAU OF VITAL STATISTICS� WHICH I ,�
<br /> , IS THE LBGAL DEPUSITORY FOR VITAL RECORDS. '
<br /> L ��}�� i�w � rt
<br /> � DIFtCCTOR OF VITAL STATISTICS AND ASSISTANT 5TAT� R�GISTRAR '�
<br /> LINCOLN, NEBRA3ICA � ssued July 22� ig83 , �
<br /> • � •�
<br /> __— _ __ : . ' ' t I
<br /> _ .. --��
<br /> , „
<br /> . ; , �l
<br /> .
<br /> ' .j
<br /> j ,_._._. __ ---. .. . . . ... . _.. _.._.._..--�-----... - �-- -_ . . . . �
<br /> , , . , �
<br />., j� , • '�i -
<br /> . i . ,
<br /> � .. - .. , . - - .
<br /> ' � ' I
<br /> . �
<br /> , . ' I
<br /> :�' .. . . � � - ' � �
<br /> _. ,
<br /> ____ : .
<br /> �. �
<br />
|