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<br />WHEN THIS COFYCIII THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE ATRUE COI'YOF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DECOSITORYFOR VITAL RECORDS. A- (/'/�'�
<br />DATEOFISSUANCE ) '"-V �
<br />ANLEYS.CbORER
<br />JAN 1 0 2002 200200481 ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STAIE OF NESMSI(A- DEFARtYlINI OF IFAI.TIIAND INAIAN SPRVICFSFMANCC AND SUR'ORT
<br />WI STATISTICS .. 0 2 0 0 0 4 4
<br />CERTIFICATE OF DEATH
<br />EiEOEx,.NA.E — FIRS _. - ATTESTS - EA N.TEOr Oe,lx ,—EYE —
<br />Anita Jessamine Cory Female January 4, 2002
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<br />Randolph, Iowa 90 e Fehruary 22, 1911
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<br />68803 Y.a® Al ❑
<br />.1 „.BMe. �ANCESIAIR, I,zw,wawE. n"100 M,nr,
<br />III PP. T, White "',Iris
<br />Leonard Owen Johnston Bertha May Sells
<br />16 WAS oEAE. FORCE, — -— ITY INFORMANT N„ME
<br />N, N eN �e.
<br />No I -- .lack Cory
<br />NFdwaANT MAi.N. AOOxa�E ,III �rox rvo ETy oP TOWN STATE. nn
<br />s 1811 W. Charles, Grand Island Nebraska 68803 _.
<br />DATE
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<br />zo k ���� ❑B. ner .Ian 8 2002 Grand Island City Cemetery
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<br />Livings t on- Sonde rmann F.H. ❑`x"M "°" ❑ °" "°' _ Grand Island, Nebraska
<br />SuxuuuroMt AONxrys nw 'LFORN. N xu OTr OxLAWN "I'S nP,
<br />c 601 N. Webb Road, Grand Island, Nebraska 68803 -4050
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<br />WHEN THIS COFYCIII THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE ATRUE COI'YOF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DECOSITORYFOR VITAL RECORDS. A- (/'/�'�
<br />DATEOFISSUANCE ) '"-V �
<br />ANLEYS.CbORER
<br />JAN 1 0 2002 200200481 ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STAIE OF NESMSI(A- DEFARtYlINI OF IFAI.TIIAND INAIAN SPRVICFSFMANCC AND SUR'ORT
<br />WI STATISTICS .. 0 2 0 0 0 4 4
<br />CERTIFICATE OF DEATH
<br />EiEOEx,.NA.E — FIRS _. - ATTESTS - EA N.TEOr Oe,lx ,—EYE —
<br />Anita Jessamine Cory Female January 4, 2002
<br />a nn nrvo sTnTE OE ewm mmei. usa eNNe✓ v, s. <ci. nn ma, .Tmr wPTx ,Mw.. m, 1-1
<br />prsi MOSS YMY6 MOODS �Oml
<br />Randolph, Iowa 90 e Fehruary 22, 1911
<br />1Y ,
<br />508-58-6328 HOSPITAL ❑ I.E., NTHEP ® F—PAR Y,
<br />so FACILITY NTP, lxew.o.w 111RE+nmawnSSAY, ❑ E H O.F.W. ❑ x..,,a
<br />,e
<br />Tiffan Square ❑ -A ❑ `— sill°—
<br />NNT TowNOPmENTIST IFFAR EaN rts wONIYw uuui
<br />Grand Island Y., [�)a N. ❑ Hall
<br />m PES OENCE s.nTE AO cONwv EN I'll mwx u«EO.,+. w ETPEETA NuMem nm✓SAFIm N
<br />m c TY Mxs
<br />1811 WxCharles Nebraska Hall Grand Island W.
<br />68803 Y.a® Al ❑
<br />.1 „.BMe. �ANCESIAIR, I,zw,wawE. n"100 M,nr,
<br />III PP. T, White "',Iris
<br />Leonard Owen Johnston Bertha May Sells
<br />16 WAS oEAE. FORCE, — -— ITY INFORMANT N„ME
<br />N, N eN �e.
<br />No I -- .lack Cory
<br />NFdwaANT MAi.N. AOOxa�E ,III �rox rvo ETy oP TOWN STATE. nn
<br />s 1811 W. Charles, Grand Island Nebraska 68803 _.
<br />DATE
<br />e, N. aB�MT oP.HE a t
<br />zo k ���� ❑B. ner .Ian 8 2002 Grand Island City Cemetery
<br />zza�` z R cEM P c o -- _
<br />Livings t on- Sonde rmann F.H. ❑`x"M "°" ❑ °" "°' _ Grand Island, Nebraska
<br />SuxuuuroMt AONxrys nw 'LFORN. N xu OTr OxLAWN "I'S nP,
<br />c 601 N. Webb Road, Grand Island, Nebraska 68803 -4050
<br />LOL E ENreRONIYONE O.O;, ✓. ,xO.Ox. N exo ei .... ><...Aa,..... +.
<br />FO J •a
<br />IOTnEP SaxigCnxl LdaOiTXTYS LrvNnws aovNimu ix5+ na PRO PART C� 1L1UbIprNSC..A✓. ACia.er.� tAUMa'�NVm1w PWA �YUw sur Fsv .s
<br />FSIY OIT10 IUPV ANY wp ml IELIOE NIU I XYO OESCNBE6NOW INIUP ORUUxNY�
<br />AN, pee ❑ t mrcl .,:kSN,,%Nl µIPM O. �,.n. iaMY SENT "FL, STPEET OP PTO NO 71, uH,Mx ETnTE ST
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<br />nv —RE 1r amn a .n.a I.N. ane °IgA . R, Ia.,.,`nwwam manim e'ni•
<br />., ve
<br />IS
<br />1 II _ T F __
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<br />E9 oNT❑ ❑ i PL S I ❑Y �
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