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MUM no COPYCAMNES THE I7fTCM1MWSS TM MLO RAISED ETRW COPY �OF THE
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE 200200808
<br />JUL 19 2001 APSWAN ;
<br />LINCOLN, NEBRASKA HEALTH AfN HlBN 4_;
<br />STATF OF NEBRASF:A- DEPARTMENT OF HEALTH AND HUMANSERYICO
<br />VRAL STATISTICS
<br />ed July 12 2001 __CERTIFICATEOFDEATH
<br />Amend --
<br />.,::.;- _ - -- M:nLr LAST J sE
<br />Mary Maxine Conroy Fe
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<br />?A Ise HOUR
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<br />MUM no COPYCAMNES THE I7fTCM1MWSS TM MLO RAISED ETRW COPY �OF THE
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE 200200808
<br />JUL 19 2001 APSWAN ;
<br />LINCOLN, NEBRASKA HEALTH AfN HlBN 4_;
<br />STATF OF NEBRASF:A- DEPARTMENT OF HEALTH AND HUMANSERYICO
<br />VRAL STATISTICS
<br />ed July 12 2001 __CERTIFICATEOFDEATH
<br />Amend --
<br />.,::.;- _ - -- M:nLr LAST J sE
<br />Mary Maxine Conroy Fe
<br />-- -
<br />-.— — -_ -- _. sa AGE- Laslennrav aNOEa/VEAR urvDEI
<br />J "B IH 11 nn1 U. A ama pwnlM
<br />%6
<br />Fairmont, Nebraska sn MOs oAYS
<br />?A Ise HOUR
<br />--- -- r9a PI. ACE OFD AL
<br />508 -54 -2630 HOSPITAL ❑ -1.11
<br />SOS 54 638 ._—
<br />❑ ER omoa:'em
<br />1- a -�_._. .. i nnrtlm, 5• - �o'mncel
<br />Good Samaritan Center ❑ ° "A
<br />r rI L. _p, arTalloN OF OEATti ea INSIDE CITY LIMITS T COUN,v OF DE.
<br />c'v u
<br />Wood River Yes [�[ No ❑ I F
<br />9c CITY. iIOWN OR LOCATION 9tl STREI
<br />DTpTC 9R GGUNTV
<br />01 0684_ -
<br />T(ATEOFDEATH V r
<br />DFV 6
<br />RAN, 1F RN" M n
<br />" "' July 16, 1924
<br />F
<br />(❑ R N,hl
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<br />9635 S. 110th Rd Yez ® rve
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<br />/aa JSUAL OCCUPA I'ON GIVa 41rMW wo�x pOnB tlwing mo5l
<br />Ekmon /ary n, SYPPP ery 10 -121 Cdbge P.a or wI
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<br />9863 South 110 RD
<br />Wood River, Nebraska
<br />68883 _ _— --
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<br />21a METHOD OF DISPOST1pry
<br />2IE DATE 21 cTETERV ORCPEMAiORV NAME
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<br />- TIME OF DEATH Y �28, PRONOUNCED DEAD I M1fI DaY vrI�2M PRGNOUNCFDDEAO INpm'
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<br />me. Aare antl pace antl nue to Ire me me Oale aM place ally one In me cause Ill sless
<br />�_ CCO OSE,ONTRIBUTE TO THE UEA I H! I+r ='•^�+ -^ ° ^," ----VES -
<br />2p ]ID IDBA
<br />NO ❑ JNKNOWN ❑ NO ❑ Y =S NG
<br />ji V ?MF AND ADORE SS7)F CERTI IER PHV$IOIAN. CORONERS PHYSICIAN OH COUNTY ATTORNEY (Type aPnnrl
<br />LARRY L HANSEN MD 3016 W FAIDLEY AVE GRAND ISLAND, NE 68803_
<br />32 DATE FILEDv ^EGISTEVE (ME Day ✓r.l
<br />p JUT" 2 6 2001
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