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WHEN THIS COPYCARMES VI RAISED SEAL OF THE NEBRASKA LTHANBik/MANSERMES
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<br />SYSTEM, ITCERRFES THE BELOW TO BE A TRUE COPYOF TNEO IOWAt'RDCORG ON FILEWITH
<br />TATISFM SECTION, WHICH
<br />Mary Jean Elder
<br />THE NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM, VITAL IS
<br />THE LEGAL UEPOSITORYFOR WTAL RECORDS. �/
<br />7, 1999
<br />PATE OF ISSUANCE
<br />200202994 gNLEY S.INBj RER
<br />`F `.
<br />JAN 2 5 1999 AD
<br />SERVICES
<br />HUMAN SYSTEM
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
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<br />Apfel`Butler- Geddes Funeral Hom
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<br />WHEN THIS COPYCARMES VI RAISED SEAL OF THE NEBRASKA LTHANBik/MANSERMES
<br />Cv
<br />SYSTEM, ITCERRFES THE BELOW TO BE A TRUE COPYOF TNEO IOWAt'RDCORG ON FILEWITH
<br />TATISFM SECTION, WHICH
<br />Mary Jean Elder
<br />THE NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM, VITAL IS
<br />THE LEGAL UEPOSITORYFOR WTAL RECORDS. �/
<br />7, 1999
<br />PATE OF ISSUANCE
<br />200202994 gNLEY S.INBj RER
<br />`F `.
<br />JAN 2 5 1999 AD
<br />SERVICES
<br />HUMAN SYSTEM
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
<br />�-
<br />STATEOFNEBRASKA- DFPAKVS1] IOFN `nf AND HUMAN $ERYIeflS.FiNMle6 ARU SOPIVRT
<br />Ogallala, Nebraska
<br />YRAL STATISTICS -
<br />December 22, 1955
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<br />December 22, 1955
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<br />Grand Island
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<br />SIDECI4LIMITS
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<br />4176 Mason Ave. 6880
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<br />Kenneth E. Elder
<br />DE, IX6CgMAM MMLMIOAOM%ES STREETORIAD."O- OTYCR.OWx STATEAPI
<br />4176 Mason Ave., Grand Island, NE. 68803
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<br />r'�E',M L /aY77
<br />®01.1.1 ❑w,�•,Jan.
<br />11, 1999
<br />Berwick Cemetery
<br />if O. CESITERYORCREMATORVLOCATION CNV COUNAR 5..11
<br />Apfel`Butler- Geddes Funeral Hom
<br />IF,.M, ❑DMIDSH
<br />Near Cairo, Nebraska
<br />FUXEWLL HOMEADOREEE MTREETw RFD. NO. CIFYORTOVN, S.ATEllnl
<br />1123 West Second, Grand Island, NE. 68801
<br />EA -,-11 111111 ONLY ONE CAUSE PER LINE FOR I11 1 AND 61) I I—F Mween omd Am EA
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