�v m i D m
<br />c n=
<br />Z
<br />in
<br />AN
<br />R 2 n o
<br />O
<br />O T
<br />p wJ n © O
<br />o A 3
<br />1,D �
<br />N
<br />v O rf
<br />N .�
<br />C.J N CD O
<br />Q\
<br />WIWN M, IT CERTi RAISED
<br />BE FA TRUE COPY Trt 0/60ILNALREDCBA TON FILES MM
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTlCSSEQTV DAI WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE 200303269
<br />SEP 2 4 2002 9k-EYS BOOPER
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEAL THAND HUMAN SERVICES SYSTEM
<br />STATEOFNEBRASKA- DET TARTMF .M ' nt MAAi;IH AND HUFTIAVSERVI nNANCEANDSf TADRT
<br />CERTIFICATE OF DEATH — 2 10120
<br />--p r ,rti TIN— Mwou w. L. ATe oFOF/ ..a a,. .n„r
<br />Melvin Eugene Leth Male DAUgust 28, 2002
<br />n nir.wD.auL..r Ai.nr A.Rr„wa,,,,,,,,e,, ,Y ACE- w,TS6rrM - – ".Ear Rrwu vwm11I
<br />Grand Island, Nebraska 50 r7_1 - s December 4, 1951
<br />Y I'll P1J1T11UMUEB PLn Ern --
<br />505 -74 -5153 o R.r ❑ I,".... OTHER ❑
<br />AN I IUNY N... r ry r „R. w,»n w,i ❑ E T.m,Mr g A.e....
<br />Residence - 314 Mallard Iane ❑ DO” ❑ D�'. n,«.e..
<br />E1 CITY TOWN DR,DE.ANDx DE DEATH
<br />r CS —TA
<br />OxNr.OEOE
<br />R. cHal1
<br />Grand Island, Nebraska
<br />.. ❑ N1
<br />5a u N E >>nE
<br />e wurvry
<br />STA,.
<br />CITY T
<br />WNORLOCATION
<br />O 6TRf£iA s R
<br />Nebraska
<br />Hall
<br />DFD ,H
<br />Grand Island
<br />314 Mallard Lane Ye: ❑ „
<br />II
<br />ITAY FEE, Ar.a Em IT
<br />"'"
<br />EEE.TAY
<br />, ;.n. T.nm„, nT�
<br />,T M.AH ED ❑INOO . NASA F,F R. 1RAY r»,rra.M, A-I
<br />' White
<br />s a °"
<br />Ehghsh
<br />❑ M FAIN °R..
<br />Marilln Jacobson
<br />-Apr>_1
<br />29 2002
<br />r na URUPEXCEPPNON
<br />app
<br />ap
<br />w. 11 MTTIE 'A'. w,AAY1
<br />dw�srvJJ,nm "e
<br />Eier,N „M,T e, 5eeenevv a,9
<br />" "r'-
<br />TPaein Officer
<br />fl
<br />Dnited Nebraska
<br />Bank
<br />- _ SURNA
<br />161nTeEANAME T MNmc
<br />ST
<br />uOTn[R r-r PADDLE MArpEN9�xgME
<br />Ray
<br />Le th
<br />Virginia Gee
<br />D, uI AR
<br />rfle INFORMANT-
<br />PN ME
<br />:.ns
<br />T. =„ nM,e.r.,er,.
<br />Not`�.�
<br />Marilyn Jacobson
<br />DA, INFORMANT SAILING ADDRESS
<br />IRTRFFT .RRFR Nn 101 THAI . nn WATI - - -_
<br />314 Mallard Lane Grand Island, NE 68801
<br />LMR„MLN,SONATURE , twtNINO — 8c8— zra T o BSnD,rYOA
<br />�. �,� ❑ Ra 1a.
<br />1E ENEnALrvoMF NAME
<br />Jacobsen- Greenway Funeral Home ❑ c. -.N- ❑ NAY-
<br />HEYART isTNAF*oRRFENC QTYCATCARY STATE SAY
<br />411 "O” Street St. Paul, WE 68873
<br />AT
<br />ANY Cardiac Arrest
<br />aE
<br />c T o s d O ExcEa
<br />AN I
<br />0
<br />D SIO111c. of
<br />It
<br />nm °OF x,MRY
<br />❑ eun ❑ A
<br />S.A. ❑ o
<br />x T D❑ r m rmumu e� ❑ AI
<br />cA NnTEAW NEA1.,a.11 111
<br />M- z EMxtn me rmv.� r -
<br />9D O
<br />eR.� I,
<br />2002 1 Elmwood Cemetery
<br />.REmrovv LICTI 1- A'OWN STATE
<br />St. Paul Nebraska
<br />ELrvnxcv IN THE ' As rr h. ❑� Yet
<br />� wMrti,H OROA. .
<br />LITE FAIAEBE ESIMJURYCEIEATFD
<br />_ram
<br />IDI STREET CAR @NO GrvORNEAR
<br />STA,.
<br />VIED ISTE YET, Y.
<br />DFD ,H
<br />Se L. 5 2002
<br />11:27
<br />pt0-
<br />ASTATEENCENTE DEAD
<br />1. DATECASEENINT)EI NA a,.,
<br />PRONOUNCED
<br />-Apr>_1
<br />29 2002
<br />app
<br />ap
<br />—
<br />--
<br />�r�� „re,TAe�.� .N 'NgaHED,"°r• /DSO
<br />.s O osE COXiRI&ITEND EIEArm ORn55uF[ NAi ENTCRAxTEm -
<br />�DTo YEE ❑ NO 29 IN.N� ❑ rMN�NA. ❑ YF. N�
<br />ERNFrEAr,r.,rEr. „wINEHEFHY= RN„RCD� YATTOaNE. — —
<br />Sgt NB Simonson, HCSO, 131 S Locust, Grand Island, NE 68801
<br />
|