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WHEN TM COPY CAMM DE RAISED SEAL CF THE NEBRASKA IIEALTHAND MMAN6ERV/GES <br />sySTEA(nCERTFES THE BELOW TO SEA TRUE COPY OF THE ORaTMAL REC0R&4WFMWTIN <br />THE NEBRASKA WALTH AND HUMAN SERVICES SYSTEM. NTAL STATIS <br />THE LEGAL DEPOSITORYFOR WTAL RECORDS. <br />DATEOPEMSUANCE 200304957 � .sl ' <br />DEC 3 2002 "sM��wT�+RTe <br />LINCOLM NEBRASKA HEALTHAND HGIIANBFRIRCE3 <br />vrru. srnnsncs G <br />r`PRTn,Tr ATP nF UFATH V <br />�. DrceDIVI w1VI —IT MIDDLE _ LPs, <br />Ex <br />A <br />n <br />In <br />November 23, 2002. - <br />.CFYANCATREOFRITR i,MMMSa. M,M°w„T,n— <br />ai <br />uxoiRIY <br />DMwE <br />: DATE OF MIRTH w,n w, RNI <br />rn <br />r <br />RoCAS <br />rn <br />= <br />October 28 1930 _ <br />- . <br />I socuaECURTY NC"ELH _. _. <br />AP ILA CL OF DEA H <br />440-32 -7793 <br />7N <br />sYJ <br />m <br />n <br />z <br />to � <br />x `•' <br />2823 Brentwood Blvd. <br />x <br />s <br />Grand Island <br />S'© N. ❑ <br />Hall <br />IISTC OR C - DUSTY <br />AT CITY TDAROPLOCATICED <br />uuxEe Ina 11. <br />Y, NIOE OT I'MIR <br />Nebraska Hall <br />Grand Island <br />2823 Brentwood Blvd. 68801 <br />YD, ❑ <br />eE p.: n. Minn <br />16T eY u'a an.eti <br />P <br />❑ DID r� EO <br />18 <br />m <br />(," r <br />E_11 <br />American <br />DIVORCED <br />°c'o <br />[� <br />Charles Upshaw <br />„R, <br />as UNPUALOOCCURATiON — R?— k-0.yAp man <br />AND OF EU NCSS ixOUSTAT <br />EWGTIpI <br />(R -1-1iy I,11 1.ov 1-1 _ <br />C D <br />mm�j.°ej <br />Nurse <br />Nursing <br />J Registered <br />s.EnTREF. NAME —IT m1DaE - -L ,ST I <br />MmxEH Rasr MODLE —1. <br />Walter S. "Smith <br />Margaret Critchell _- <br />- <br />T11 <br />? <br />—1 T <br />212 Lakeside Drive, Grand Island, Nebraska 68801 <br />_. <br />R- SK.rv,T aLeEN. -rvo. -- <br />NFrwoCF OSEDS *ox <br />i+o: DAre <br />'Werllawa <br />cLMErzA. on c" ".TOA. NAME <br />41071 <br />❑° _� ❑A° <br />November 26, 2002 <br />Memotlal Park Cremnlnry <br />FUrvEa+ LiOME -NAMk k <br />4 <br />All Faiths Funeral Home <br />°rtm•°^ ❑°i' ° <br />°' Grand Island, Nebraska - <br />roNCnALHOMEACOAESS IETPEELORRRO. NO Gry x,gaN..STATF. SPR <br />2929 S. Locust St., Grand Island, Nebraska 68801 <br />MMEakTruOSE TENTER ONLV Oxe causE RER MNE roN �.�roi AND iui mw... A',R, <br />OAR <br />L1AAl CA 4( <br />W[TO,g1 A5,CO,L5E0UEHLE OF i • mx ue.nr <br />- _— <br />m�ECE:aoRS.wNELWLNceoF <br />- - iM.�•,imwLM. °.a,„. °�., °. <br />AI FCTI —FIWNT CONSm NA- cmeo�on<< °M.�dxnsm m.adi. wi m•niMw ni ii FEMUE w.sTHEAt, ,LOOrs. REFERRED *o MEOiat <br />R< <br />FA <br />rAEONnvorwTHERASra MONTHSy .M. OH COmONEm <br />e <br />IRIS, n n ® Tn ❑ x <br />5- DATEDFN,URr 1MRw„.,, <br />oAOF,N°MP7 <br />ME — EHMyWLx � <br />o,aM ❑N ,m <br />❑ s.w ❑ R �� <br />_�. � <br />-o <br />�M ia,OURr -a. gym.. e�m.,M.M.iKm <br />Ms.«cATiory STREET OR ARO.NO. CITY N ,...r <br />N <br />e,oT <br />vn, <br />N, <br />- <br />-tP0 <br />- - - 1111ENEO 1.. W, , TiMECf OH.TH <br />oP DATE OF OE, REA. DRY <br />November 23 2002 <br />M <br />• } n1 DATE 1 L TIME OF DEATH r nc RH •. <br />OxOUNLED DERO � 386 <br />.. <br />9:26 s M <br />O <br />v <br />(1 <br />_ s °.N ���M. _ _ _ <br />T <br />uiETOMFDFATXt - HA.vow,x n Fmxn CON6ICEPED +T' 'M5 Wn4CONEEHTGRUa erv+ <br />OiO �a OH❑ <br />F1 TE9ACrvimA ❑ uxxrvOwx vW )!� NO ❑ YE9 �uo <br />x- IANDADDPE55 TIFl H P- RI.IAH. M N A RmSWxOArA TTY11CM EV1 wn <br />David R. Colan, M.D., 729 North Custer Avenue, Grand Island, Nebraska 68803 <br />s. aEDeT o TE,,IEDE DEC �J Y2602 <br />r0 <br />N <br />Suite No. 2823, Pinewood <br />Condominium <br />in <br />the <br />City of <br />Grand Island, <br />Hall County, Nebraska. <br />WHEN TM COPY CAMM DE RAISED SEAL CF THE NEBRASKA IIEALTHAND MMAN6ERV/GES <br />sySTEA(nCERTFES THE BELOW TO SEA TRUE COPY OF THE ORaTMAL REC0R&4WFMWTIN <br />THE NEBRASKA WALTH AND HUMAN SERVICES SYSTEM. NTAL STATIS <br />THE LEGAL DEPOSITORYFOR WTAL RECORDS. <br />DATEOPEMSUANCE 200304957 � .sl ' <br />DEC 3 2002 "sM��wT�+RTe <br />LINCOLM NEBRASKA HEALTHAND HGIIANBFRIRCE3 <br />vrru. srnnsncs G <br />r`PRTn,Tr ATP nF UFATH V <br />�. DrceDIVI w1VI —IT MIDDLE _ LPs, <br />Ex <br />D .w°, <br />ATEOFCRAIR ,NO,...wn <br />Margaret S. Upshaw <br />Female <br />November 23, 2002. - <br />.CFYANCATREOFRITR i,MMMSa. M,M°w„T,n— <br />ai <br />uxoiRIY <br />DMwE <br />: DATE OF MIRTH w,n w, RNI <br />" °" <br />RoCAS <br />North Sydney, Nova Scotia, Canada <br />72 <br />October 28 1930 _ <br />- . <br />I socuaECURTY NC"ELH _. _. <br />AP ILA CL OF DEA H <br />440-32 -7793 <br />IAVIRTAL ❑ MRMi.M OTHER ❑ A —gH °m. <br />❑ EP.. —P. ® wRREA y <br />2823 Brentwood Blvd. <br />❑ WA ❑ aMN s..:�. <br />s <br />Grand Island <br />S'© N. ❑ <br />Hall <br />IISTC OR C - DUSTY <br />AT CITY TDAROPLOCATICED <br />uuxEe Ina 11. <br />Y, NIOE OT I'MIR <br />Nebraska Hall <br />Grand Island <br />2823 Brentwood Blvd. 68801 <br />YD, ❑ <br />eE p.: n. Minn <br />16T eY u'a an.eti <br />P <br />❑ DID r� EO <br />18 <br />11 rvnuF OF SPO�St , rmi <br />E"" "' White <br />E_11 <br />American <br />DIVORCED <br />°c'o <br />[� <br />Charles Upshaw <br />„R, <br />as UNPUALOOCCURATiON — R?— k-0.yAp man <br />AND OF EU NCSS ixOUSTAT <br />EWGTIpI <br />(R -1-1iy I,11 1.ov 1-1 _ <br />ORS, vmf i <br />"°'°`12ry 0r YLG1 ° ° " ° "' 4 <br />mm�j.°ej <br />Nurse <br />Nursing <br />J Registered <br />s.EnTREF. NAME —IT m1DaE - -L ,ST I <br />MmxEH Rasr MODLE —1. <br />Walter S. "Smith <br />Margaret Critchell _- <br />- <br />Os: ARMED - iCESAVADT. NAME <br />YA, ECFnsro <br />,, ° °, Fyn y.......N °.N,°1>a. TV,i Dr. Anne Morse_ <br />OR INFORMANT tit U- 111oxESE ETVEETOPRFO UOAiry <br />212 Lakeside Drive, Grand Island, Nebraska 68801 <br />_. <br />R- SK.rv,T aLeEN. -rvo. -- <br />NFrwoCF OSEDS *ox <br />i+o: DAre <br />'Werllawa <br />cLMErzA. on c" ".TOA. NAME <br />41071 <br />❑° _� ❑A° <br />November 26, 2002 <br />Memotlal Park Cremnlnry <br />FUrvEa+ LiOME -NAMk k <br />211 rFMCTEAYCACAEMATOWLOCATnry cTy ORTOXx skit <br />All Faiths Funeral Home <br />°rtm•°^ ❑°i' ° <br />°' Grand Island, Nebraska - <br />roNCnALHOMEACOAESS IETPEELORRRO. NO Gry x,gaN..STATF. SPR <br />2929 S. Locust St., Grand Island, Nebraska 68801 <br />MMEakTruOSE TENTER ONLV Oxe causE RER MNE roN �.�roi AND iui mw... A',R, <br />OAR <br />L1AAl CA 4( <br />W[TO,g1 A5,CO,L5E0UEHLE OF i • mx ue.nr <br />- _— <br />m�ECE:aoRS.wNELWLNceoF <br />- - iM.�•,imwLM. °.a,„. °�., °. <br />AI FCTI —FIWNT CONSm NA- cmeo�on<< °M.�dxnsm m.adi. wi m•niMw ni ii FEMUE w.sTHEAt, ,LOOrs. REFERRED *o MEOiat <br />R< <br />FA <br />rAEONnvorwTHERASra MONTHSy .M. OH COmONEm <br />e <br />IRIS, n n ® Tn ❑ x <br />5- DATEDFN,URr 1MRw„.,, <br />oAOF,N°MP7 <br />ME — EHMyWLx � <br />o,aM ❑N ,m <br />❑ s.w ❑ R �� <br />_�. � <br />-o <br />�M ia,OURr -a. gym.. e�m.,M.M.iKm <br />Ms.«cATiory STREET OR ARO.NO. CITY N ,...r <br />m� „ <br />H <br />e,oT <br />vn, <br />N, <br />- <br />-tP0 <br />- - - 1111ENEO 1.. W, , TiMECf OH.TH <br />oP DATE OF OE, REA. DRY <br />November 23 2002 <br />M <br />• } n1 DATE 1 L TIME OF DEATH r nc RH •. <br />OxOUNLED DERO � 386 <br />.. <br />9:26 s M <br />IS T.M M ,n, .,.° .M °,L.n <br />�u:r.i <br />(1 <br />_ s °.N ���M. _ _ _ <br />T <br />uiETOMFDFATXt - HA.vow,x n Fmxn CON6ICEPED +T' 'M5 Wn4CONEEHTGRUa erv+ <br />OiO �a OH❑ <br />F1 TE9ACrvimA ❑ uxxrvOwx vW )!� NO ❑ YE9 �uo <br />x- IANDADDPE55 TIFl H P- RI.IAH. M N A RmSWxOArA TTY11CM EV1 wn <br />David R. Colan, M.D., 729 North Custer Avenue, Grand Island, Nebraska 68803 <br />s. aEDeT o TE,,IEDE DEC �J Y2602 <br />r <br />O( <br />(D <br />N OL <br />O <br />O <br />O C <br />S <br />CO � <br />� r-r <br />y � <br />