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IRS <br />C In = j n (0, o <br />m <br />Y1 A Z A 2 \ "� z z� <br />m NiN o � <br />ii W O T <br />CD <br />CO 3 <br />caCl N ,{}' F' N <br />2 <br />0 <br />s <br />ZQ0305�97 <br />WHENTFYSCDWCMRES TM RAISED SEAL OF THE NEBRASKA HEALTHAMIBM ANSElIVICES <br />SYSTEM, RCERRFE8THE BELOW TO BE ATRIE COPY OF THE ORIGINALARE02RDIONIKE WITH <br />THE NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM, VITAL STABSR IS SOmOf(I.WIACH IS <br />THE LEGAL DEPOSITORYFOR VITAL RECORD& = _ <br />DATE OF ISSUANCE i <br />//����pp pjI �������� ARSIS,iANTSTATEREOMTIRAR <br />ELMDOLMYiCBN'A " HEALTHANDIAMyN$iM4A7;S SYSTEM <br />STATE OF N ®RASKA- D @MTAPaNT OF EPALM AND HUMAN SW$'N.BS PMANP,BAMDSUPPORT <br />vITAL STATISna 0 3 03847 <br />rTnETIPICAW nF DFATH <br />I oa�tutw -rvAMI Fias NooEE - w6T <br />EN <br />HAITI nEATN DAY.vw - <br />Glenn Arthur Mays <br />Male <br />March 27, 2003 <br />a Crtv Ax05LREOF OiPiX ryxJn US. -vme— I <br />Y10E CARE..V <br />NEAP <br />PI MV <br />AMT' DR WITH IFW. CAM Vw <br />AT AIDS I .,I <br />xHODPS mN6 <br />Doniphan, Nebraska <br />111, 75 <br />April 17, 1927 <br />TODOAl sSCVxT�. rvuxoEa - <br />LACE OF DEA <br />X ❑ InNNn oTNrx. ❑ <br />507 -24 -5394 <br />M]6PI?u <br />❑ Sw:d ❑ " <br />❑ EP wIP,w IL MAeAAA <br />m F.IIIT..xAI.A WI..,.a..a,,aw+W —WAWW <br />Home: 305 Circle Drive <br />❑DOA ❑ <br />C,TONWIR LDC+TiON IT DEATH <br />I.S.A. Cm uw <br />Al BeI <br />eaCOVxTYOFDAA- <br />Doniphan <br />©NM ❑ <br />Hall <br />w w couxry <br />n.cmrowu oP EOCaTOx <br />m SmEET AxD xuu¢EP ImxaaMNZw ew,l <br />cecoY.IA«xs <br />Neba Ha11 <br />Doniphan <br />305 Circle Drive 68832 <br />., ®NA ❑ <br />IPACE IeyA, A—Mm <br />2Y. >PWOU"11 FPD /AW.TRI <br />MARSED WIOLWED <br />NAME OR.ADDP. fXµ PwnuflniniF""¢"'x <br />"ite <br />;Wh <br />IE°°` "' American <br />Helen D. Koertje <br />. SALOW mml A AD OF BUYNES0__IT- <br />'ry,M ae <br />SE CA_ <br />SPAYIY 1 �AN�ML <br />6,m'xary D.IxICeege <br />icA7 <br />Rural ex Carrier /Owner octal Service / Mays Elett <br />IN FArX'P -xAME I-' Mroa' us. <br />MoTXIS nusT NDDIC wlcex wPNANE <br />Arthur Wayne Mays <br />7eanet re Peabody <br />EO EVEP U6 AR Fp1LEST <br />IBTI506G6 N <br />10+ INFOPNAM -NPME <br />neA. �Arvmrl areA. S�wweb aA1 ;,.vNMI <br />Helen Ma s <br />Y <br />Yes: II 7 23 194 6 2 1 46 <br />sy' <br />it ,r, n.,,,..... ..................... ___._._.._____. _. - _ <br />305 Circle Drive, P.O. Box 276, Doniphan, NE 68832 <br />1123 West <br />®. ❑P M <br />❑o.NNN ❑DArw. <br />Grand Island, NE. <br />Cedarview <br />EP SGNI ¢pPr <br />ILAM LONdiIONS CaeiM-e-11-11— <br />OIUFEU FwuSiX¢PEA 2a AVFOFSV- <br />E. WAS CASEPEFFANED TOUEOIGAI <br />IAH ¢EONANCVwTHtvw4T]vOxrxS+ <br />F%ANNEN pi COWNEm <br />" <br />DIA/S %fi5 <br />ABW,W, A <br />A NMry INY.M nl <br />DAY MJIIP D, WVPV <br />ILTnenHOW Iw.IM OCCUPPEDY� <br />❑ ¢rn m ❑ U -AYIT <br />❑ Sw:d ❑ " <br />TWdM <br />EM.¢ACECF WVrs. � .Wm, xxex luny <br />26p. EOLAIION STPEEI OUµFO. NO CITY 011 iOMN Si.1TE <br />❑ Nmcm mrm4 H <br />WA L1 -❑ <br />dMN9 <br />xIa MTEL£f£Arx 1- -1VVr1 <br />OATE90NED. GAY" I <br />RED TIME OF OEAm <br />d <br />-A ATS —D. PAI-"1 <br />no. TMIEOF OEATN <br />2Y. >PWOU"11 FPD /AW.TRI <br />WA'TH"CHNCEDDEAD IIbwI <br />€k <br />$ <br />AIR <br />1. RR <br />Pw <br />"'- <br />AI <br />zee "mn <br />sy' <br />_ <br />� RIA <br />Je a <br />wu.wro,iwa:wAw <br />IS <br />W;b <br />IS gD�O& IJDATONT E THE DEI.1. <br />HAS CROWN qI TASHE IDR. BEEN Cp19NEPED <br />a WA600MiNTLPANTEDY <br />17 ❑ <br />❑ YES NO <br />❑ VES IAT <br />NO <br />YES WRxO.VM <br />IT NAVE -I A00PESS OR EPTIEW 1MY91ONNCM >FOSRIFSIfYMOPLOUNxYA1TLANEYI <br />David Colan M.D. 729 N Custer, Grand Island NE. 68803 <br />xv,. REGISTER <br />DATE FUD By PEDrsTNNN WA CRY Y4 <br />APR - 7 2003 <br />