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WHEN RpS COPYCARFWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM.ITCERTpiES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ON FILENTTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />JJUu1■ g�ry� Gv &tANLEY DATEOFISSUANCE
<br />NEBRAG SICA 2 0 0 2 0 7 7 `� HEALTH AND C�T RAff
<br />STAn OF NEBIUI nEPANITIEM OFHEE�TR AHTn UNLkN SC ICES FINANCE AND SIjBP�]IfT 0701
<br />CERTIFICA I OF DEAT11 - U (J CJ
<br />LISTe. .,.:,... .....,
<br />HTlO Hobert Kozak Sr. Hale .June 26, 2002
<br />Saline County, Nebraska 1 -je 90
<br />r CcN.$ CNem..weeN
<br />A. 508-10 -2309
<br />�St. Francis Medical Center
<br />LIT, rowNa+mcArbNOw H -
<br />Grand Island
<br />A N_ err 11 CTI LOAD
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<br />�s..
<br />July 21, 1911
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<br />LEGAL DESCRIPTION:
<br />Lot Six (6),
<br />Block B, Boehm's
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<br />Island,
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<br />Hall County,
<br />Nebraska.
<br />WHEN RpS COPYCARFWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM.ITCERTpiES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ON FILENTTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />JJUu1■ g�ry� Gv &tANLEY DATEOFISSUANCE
<br />NEBRAG SICA 2 0 0 2 0 7 7 `� HEALTH AND C�T RAff
<br />STAn OF NEBIUI nEPANITIEM OFHEE�TR AHTn UNLkN SC ICES FINANCE AND SIjBP�]IfT 0701
<br />CERTIFICA I OF DEAT11 - U (J CJ
<br />LISTe. .,.:,... .....,
<br />HTlO Hobert Kozak Sr. Hale .June 26, 2002
<br />Saline County, Nebraska 1 -je 90
<br />r CcN.$ CNem..weeN
<br />A. 508-10 -2309
<br />�St. Francis Medical Center
<br />LIT, rowNa+mcArbNOw H -
<br />Grand Island
<br />A N_ err 11 CTI LOAD
<br />,o �ws
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<br />MOOR n�NS
<br />�s..
<br />July 21, 1911
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<br />Nebraska Hall i Grand Island
<br />" White P," American
<br />0 wnem 'IN"L
<br />ITAL Truck Driver '1
<br />EATNm -NAiDI NNS u�ooEe -- CA
<br />Charles Koz,
<br />18 11L DECEASED �Vll I' 1" 1-1 11 1 T11-11
<br />a.. ..... ...N..........
<br />No Bernadine Kozak
<br />1018 West Louis., Grand Tsland N68801
<br />a SANA A N C 0
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<br />-I E NE 1-1I, .... I
<br />Apfel- Sutler- Geddes 1 1 1 °io... El ' ° "" °"
<br />1018 West Louise 68801'.
<br />Bernadine Buettner
<br />0 IB
<br />FlAS, Cen Y A)ELE ] MAIDEN 61PNMIP
<br />Emma Cochnar
<br />a_cEUEreA. oAwE�.A,or uertrt
<br />2002 Grand Tsland Cemetery
<br />Grand Island, NE.
<br />1123 West Second, Grand Island NE. 68801 -5899
<br />1 v, CAUSE FFALINE AND 11, _—
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<br />Steven L. Husen M.U. 2116 W. Faidley Ave., Ste, #400, Grand Island, NE. 68803
<br />Ex. NEesMN ,,:, r.,E=o aveeurtiixnN ,M.,. N.,
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<br />Steven L. Husen M.U. 2116 W. Faidley Ave., Ste, #400, Grand Island, NE. 68803
<br />Ex. NEesMN ,,:, r.,E=o aveeurtiixnN ,M.,. N.,
<br />
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