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<br />R CERTM$ THE BELOW TO BE TRUE COPY OF AN ORIGINAL RECORD
<br />�i DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, V NICH IS IN
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE 200300492
<br />S
<br />7
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<br />DEC 2 7 1996 ASSIErANT ST TdZ
<br />LINCOLN, NEBRAS" NEBRASKA OEPIARTN!kr - -OI
<br />STATE OF NEBRASKA - DEIIARTNENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
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<br />Ru. .FDISTIUR
<br />VA,E ELEPDY REPISiRAR IN+. De. Vp
<br />DEC 2 R 'qy6
<br />N
<br />!� VVHSV THAI COPYCARRISS THE RAISED SEAL OF THE NEBRASKA STATE
<br />R CERTM$ THE BELOW TO BE TRUE COPY OF AN ORIGINAL RECORD
<br />�i DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, V NICH IS IN
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE 200300492
<br />S
<br />7
<br />ST rs.
<br />DEC 2 7 1996 ASSIErANT ST TdZ
<br />LINCOLN, NEBRAS" NEBRASKA OEPIARTN!kr - -OI
<br />STATE OF NEBRASKA - DEIIARTNENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />cEl>ExT NAME Pettt NIDaE vsT
<br />3. su
<br />R .reoF oF.TR I.b,. wv. n.N
<br />Willard Marion Goldenstein
<br />Male
<br />December 15, 1996
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<br />&atherine NMN Eich
<br />As DECwsED ExER W us,A
<br />ePa.IN•aES7Z1'
<br />WvawAxr.xxxE
<br />pIrnetta
<br />mviT*'
<br />YES WWII 10 24 41 -10
<br />Jean Goldenstein
<br />W,Dwawr NPUxa AWRESS IsT— roR RFD. xP,ary wTOrm.9rArt.R»
<br />515 West 13th, Grand Island, Nebraska 68801
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<br />❑°ine°' ❑°°"ep"
<br />Glenvil, Nebraska
<br />FUNERAL H— AWRess 191g EN --,n. xo_cm ox Twm.sTArenn
<br />505 West Koenig, Grand Island, Nebraska 68801
<br />MNEM9TE UU3E IENrER.1 ORR.. PEA LFRE RON lei lm. aR0 111
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<br />Steven L. Husen, M.D. 21 W. Faidl y, Suite 400, Grand Island, NE 68803
<br />Ru. .FDISTIUR
<br />VA,E ELEPDY REPISiRAR IN+. De. Vp
<br />DEC 2 R 'qy6
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