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1- 1 On <br />E <br />� o <br />z E <br />w <br />o A <br />w _ <br />w <br />o� <br />oL <br />w `m <br />E � <br />Z li <br />n <br />STATE OF NEBRASKA - DEPARTMENT nF XEALTH <br />BUREAU OF VITA4 STATISTICS <br />CERTIFICATE OF DEATH <br />200202718 <br />"M IM. Md E <br />❑ A.Exx � , <br />❑.x»r I <br />❑ 1r ❑ <br />Fre. - A.1. nx ..r 11rs.r.AIN a IT r <br />x 128 -94 x 7:70 A <br />.u.f ,vxfo r �( /[ f'^'L �^'T'.'^ y� BlgNdrNLEOOEIO M4 PY .rI Ttl PKW.MCFUMIO . <br />.ne-w em, E M 1� -25- 4 8:40,.1., A <br />P umin d� YxNI� / LESf+ <br />Us xMriE \D INE UEA.M. NAll dtlNIp111sELE WNAIW O[ExLM4CEPF0. AB WASLPI IEO• <br />�.o x rA x ®MNx x ❑ .EE K- o <br />01 <br />N..]w. AppIE SE,, II.11lf II.YE1fMN LdgNER90xy.U1lalmiv AII.V1I Ilpw/+PII <br />TCaptain William HollOway, Grand Island Police Department, Grand_I_s] <br />- -' �fYFOOV I'ECYiIMR xb.M nl <br />e LEfabnux - <br />FOR VITAL STATISTICS USE ONLY <br />rlaLe.. a ...... .......A.......,. c_..... ............D <br />NEC............ __... ........... .. ............. <br />WDrk.. ___.... __._ .............. .. __. <br />UC.. _._.. ._.......,.... _._. ................. _. _. <br />ReleCl ..... ... ...... .... <br />I hereby certify this to be a true and correct copy of the original <br />filed with the State of Nebraska <br />r� _ `'. ,b,lrinn G � c y .. Ar 3 �LhLJ�..c {_ <br />Signed tliis - —w— `Io, e' <br />E ___ .. ................ PmI11 ... TMV ... <br />III GLNERAL NOTARQ ' <br />TERRY L -Z MY Comm. Ex <br />Yx <br />IJ 1 <br />and. <br />Theresa C iii. Creenw It FIe..IC /a Inry 25 1994 <br />A.M EaEYI� w.ro <br />69 �_ March_ 5 <br />8C. Libory_,_.Nebreska _ 6 <br />.Ml sncwx. NxN „xxFx ❑ x ,p <br />505 -76 -7705 ._— �, „„,,,,„ U „„r, <br />n ro+ - - <br />224 W ]6th n <br />M c,. )a ocA. oN Or ou <br />�[� f_j Hall <br />Grand island _ <br />_ — <br />T.IT <br />Am T <br />a v.m 1Whi Le American "E.Ex ° Lawrence <br />Ix UEIM w <br />w.TnI�U• N <br />FUUSL $f'ry ire {tO9- Btll I.WRNENnUMF <br />B.EUNEx MnE EPEI s - <br />Clara- _ <br />John NMN Jane en C <br />• .E VAI RCf AEEM WEn x U9 MME0 iUn[f .M Vml f. <br />ryx.¢u.1 V <br />No a <br />IW INr VIANI - M01xp Agmfss BIIUTMxrU.q. MT—TION. nAlE. IVI <br />24 W. 16th Grand Island Nebraska _ <br />_68801 Nom. _ <br />f <br />_ M <br />❑c..M.❑ox. <br />(;read Island Nebraska _ <br />LfvEM tonNEAOndermann F H. ❑ <br />EVN1&& MEAOw,S. rs.xl.RR MNMal.ox,w.w.wA.i. z1n <br />505 West Koenig, Grand Island, Nebraska 68801 <br />MuIgA,ECWOE— IFxlEngwv UnE Ulfif BEN 1MEfM InI M..NO kll <br />m <br />I Cardiac arrest U <br />K .N I <br />Congenital heart disease Years <br />M C <br />19 a <br />aU. �ms.T NxE.F - <br />FOR VITAL STATISTICS USE ONLY <br />rlaLe.. a ...... .......A.......,. c_..... ............D <br />NEC............ __... ........... .. ............. <br />WDrk.. ___.... __._ .............. .. __. <br />UC.. _._.. ._.......,.... _._. ................. _. _. <br />ReleCl ..... ... ...... .... <br />I hereby certify this to be a true and correct copy of the original <br />filed with the State of Nebraska <br />r� _ `'. ,b,lrinn G � c y .. Ar 3 �LhLJ�..c {_ <br />Signed tliis - —w— `Io, e' <br />E ___ .. ................ PmI11 ... TMV ... <br />III GLNERAL NOTARQ ' <br />TERRY L -Z MY Comm. Ex <br />Yx <br />IJ 1 <br />and. <br />