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<br />WHEN TINS COPYCAFWS TOE RAISED SEAL OF THE NEBRASKA HEALTHANDHUMAN SERVICES
<br />SYSTEM, TECEIiII ThE BELOW TO BE ATRUE COPYOF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA MEALTN AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTIOM WINCH IS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS. yr
<br />DATE OF ISSUANCE /µ'�•rOO
<br />AUG 2 8 2002 200210051 ANLEY S. COOPER
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE OF NEBRASKA- DEPARTSgNI'OF MEAH1,1711 AND II IMAM SERVICES MANGE AHORIIEFORT
<br />MDUL STATISTICS
<br />CERTIFICATE OF DEATH 02 09796
<br />.Eli -OFU nME FlFE +mmL LAST D a FD Tn , vA 11, , r �e
<br />Marjorie A. Repenn. ] EFemale August 17, 2002
<br />,.YAK nTF OF RIRTN Mme 'AS i„a,,..a,r,mr r TE OE e,RTR ,AANOT Ear va,.i
<br />, Germany s m.. 75 s> uoBER D.Y N '" December 21, 1926
<br />T Sd AL EROTE YNUMB E a vu1EOi DEATr
<br />506 -14 -6695 Nos �T.wu..I ® FRAINUTTY,
<br />B Saint Francis Skilled Care ❑ wA ❑ Ao..rssKAv
<br />Grand Island J_A° ❑FNR ❑ Hall
<br />N, glOtnP �BqF IXWNT' Cm TOWNCELOA7T11" e1m2CHAED 1—. ermr9ly f¢e. 1..,
<br />A Nebraska a Merrick Palmer 911 Templin FR 68864
<br />A "CEi'RLy y' ANLFBTm:eg num Meun GO,m"ON, IErEEPED WIDOWED BNAMEDFBVOUSE lIDN -ITA,.I
<br />Irirican -F Henry Otto Repenn
<br />OCRAN uSWL WOUVanOry ry —Oder wmROUNES xa RIND OF BUSINESS INDUSTRY .peuryonryn vael
<br />Aq a.ary AT ,iElAYIw SO 1Z C. At
<br />a Nursing Home g
<br />F.TRER.N _- IIwI MIDOIF .A MOIXEP - -. FIRST .'.AC —11 IN 11 N,NAN
<br />Etlwartl Miller Catherine Naheur
<br />S. �MEDNo ESP -.1 S Iry INFU" -ANI. MF
<br />W e -_
<br />,B won O N BAFFr FY,Yn.
<br />IF III a.a ARFO I Henry Otto Repenn_ _
<br />OEMAei MArLIN"ADONLSD rATRFFT ON R FO NO III OR TOVIT STATE DO
<br />a% Palmer, NE 68864
<br />/ /02� [xer,r,a ❑ R. Aug 20, 2002 LRoss Hill
<br />21d CEMETERY OR 111MATORY LACITEEN
<br />N.
<br />Solt Funeral Home
<br />❑REI ❑IN.eI
<br />Palmer
<br />Nebraska
<br />,,F bSOREET OR P F O. NO. CI RTd N.
<br />,uL RoMUOO 63 iV0
<br />STATE. Set --
<br />'
<br />C D
<br />1507 17th Street, Central City, NE 68826.
<br />AugF 17, 2002
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<br />WHEN TINS COPYCAFWS TOE RAISED SEAL OF THE NEBRASKA HEALTHANDHUMAN SERVICES
<br />SYSTEM, TECEIiII ThE BELOW TO BE ATRUE COPYOF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA MEALTN AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTIOM WINCH IS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS. yr
<br />DATE OF ISSUANCE /µ'�•rOO
<br />AUG 2 8 2002 200210051 ANLEY S. COOPER
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE OF NEBRASKA- DEPARTSgNI'OF MEAH1,1711 AND II IMAM SERVICES MANGE AHORIIEFORT
<br />MDUL STATISTICS
<br />CERTIFICATE OF DEATH 02 09796
<br />.Eli -OFU nME FlFE +mmL LAST D a FD Tn , vA 11, , r �e
<br />Marjorie A. Repenn. ] EFemale August 17, 2002
<br />,.YAK nTF OF RIRTN Mme 'AS i„a,,..a,r,mr r TE OE e,RTR ,AANOT Ear va,.i
<br />, Germany s m.. 75 s> uoBER D.Y N '" December 21, 1926
<br />T Sd AL EROTE YNUMB E a vu1EOi DEATr
<br />506 -14 -6695 Nos �T.wu..I ® FRAINUTTY,
<br />B Saint Francis Skilled Care ❑ wA ❑ Ao..rssKAv
<br />Grand Island J_A° ❑FNR ❑ Hall
<br />N, glOtnP �BqF IXWNT' Cm TOWNCELOA7T11" e1m2CHAED 1—. ermr9ly f¢e. 1..,
<br />A Nebraska a Merrick Palmer 911 Templin FR 68864
<br />A "CEi'RLy y' ANLFBTm:eg num Meun GO,m"ON, IErEEPED WIDOWED BNAMEDFBVOUSE lIDN -ITA,.I
<br />Irirican -F Henry Otto Repenn
<br />OCRAN uSWL WOUVanOry ry —Oder wmROUNES xa RIND OF BUSINESS INDUSTRY .peuryonryn vael
<br />Aq a.ary AT ,iElAYIw SO 1Z C. At
<br />a Nursing Home g
<br />F.TRER.N _- IIwI MIDOIF .A MOIXEP - -. FIRST .'.AC —11 IN 11 N,NAN
<br />Etlwartl Miller Catherine Naheur
<br />S. �MEDNo ESP -.1 S Iry INFU" -ANI. MF
<br />W e -_
<br />,B won O N BAFFr FY,Yn.
<br />IF III a.a ARFO I Henry Otto Repenn_ _
<br />OEMAei MArLIN"ADONLSD rATRFFT ON R FO NO III OR TOVIT STATE DO
<br />a% Palmer, NE 68864
<br />/ /02� [xer,r,a ❑ R. Aug 20, 2002 LRoss Hill
<br />21d CEMETERY OR 111MATORY LACITEEN
<br />N.
<br />Solt Funeral Home
<br />❑REI ❑IN.eI
<br />Palmer
<br />Nebraska
<br />,,F bSOREET OR P F O. NO. CI RTd N.
<br />,uL RoMUOO 63 iV0
<br />STATE. Set --
<br />'
<br />C D
<br />1507 17th Street, Central City, NE 68826.
<br />AugF 17, 2002
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<br />SYSTEM, TECEIiII ThE BELOW TO BE ATRUE COPYOF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA MEALTN AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTIOM WINCH IS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS. yr
<br />DATE OF ISSUANCE /µ'�•rOO
<br />AUG 2 8 2002 200210051 ANLEY S. COOPER
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE OF NEBRASKA- DEPARTSgNI'OF MEAH1,1711 AND II IMAM SERVICES MANGE AHORIIEFORT
<br />MDUL STATISTICS
<br />CERTIFICATE OF DEATH 02 09796
<br />.Eli -OFU nME FlFE +mmL LAST D a FD Tn , vA 11, , r �e
<br />Marjorie A. Repenn. ] EFemale August 17, 2002
<br />,.YAK nTF OF RIRTN Mme 'AS i„a,,..a,r,mr r TE OE e,RTR ,AANOT Ear va,.i
<br />, Germany s m.. 75 s> uoBER D.Y N '" December 21, 1926
<br />T Sd AL EROTE YNUMB E a vu1EOi DEATr
<br />506 -14 -6695 Nos �T.wu..I ® FRAINUTTY,
<br />B Saint Francis Skilled Care ❑ wA ❑ Ao..rssKAv
<br />Grand Island J_A° ❑FNR ❑ Hall
<br />N, glOtnP �BqF IXWNT' Cm TOWNCELOA7T11" e1m2CHAED 1—. ermr9ly f¢e. 1..,
<br />A Nebraska a Merrick Palmer 911 Templin FR 68864
<br />A "CEi'RLy y' ANLFBTm:eg num Meun GO,m"ON, IErEEPED WIDOWED BNAMEDFBVOUSE lIDN -ITA,.I
<br />Irirican -F Henry Otto Repenn
<br />OCRAN uSWL WOUVanOry ry —Oder wmROUNES xa RIND OF BUSINESS INDUSTRY .peuryonryn vael
<br />Aq a.ary AT ,iElAYIw SO 1Z C. At
<br />a Nursing Home g
<br />F.TRER.N _- IIwI MIDOIF .A MOIXEP - -. FIRST .'.AC —11 IN 11 N,NAN
<br />Etlwartl Miller Catherine Naheur
<br />S. �MEDNo ESP -.1 S Iry INFU" -ANI. MF
<br />W e -_
<br />,B won O N BAFFr FY,Yn.
<br />IF III a.a ARFO I Henry Otto Repenn_ _
<br />OEMAei MArLIN"ADONLSD rATRFFT ON R FO NO III OR TOVIT STATE DO
<br />a% Palmer, NE 68864
<br />/ /02� [xer,r,a ❑ R. Aug 20, 2002 LRoss Hill
<br />21d CEMETERY OR 111MATORY LACITEEN
<br />N.
<br />Solt Funeral Home
<br />❑REI ❑IN.eI
<br />Palmer
<br />Nebraska
<br />,,F bSOREET OR P F O. NO. CI RTd N.
<br />,uL RoMUOO 63 iV0
<br />STATE. Set --
<br />'
<br />Ir.ABreeeY br
<br />1507 17th Street, Central City, NE 68826.
<br />AugF 17, 2002
<br />MEO ENT NuxLV ONL'
<br />IN FORIe, 1ANNIII
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<br />2116 West
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<br />IGNED /M, .A nl IFL TIMEOF OEaTR
<br />u"ceD DE.O At en..m 211 PRONOUNUEB OF..T --
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