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WHEN THL4 COPYCARRES TIE RAISED SEAL OF THE NEBRASKA HEALTHAND HUMAN SERVICES
<br />SYSTEM FTCERTFES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, i1TACSTAUSMS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS. `
<br />DATE OF ISSUANCE 2O021�
<br />lI 1.29 .G✓ r��AMLEYA'COOPER
<br />NOV 2 8 2001 AS3ISTANTSFA(srRAR
<br />LINCOLN, NEBRASKA NEALTHANDHUMAN SSYSTEM
<br />STATE OF NEBRASKA- DEPARTMENT OF IQiyLTHTtffi- HUMANSERVICES'IIN VICE AND SUPPoRT
<br />YITAESTATESTiC5`-- - 01 12998
<br />I OFCeoervr SAYE FEST M DDLE LAST = _
<br />fSEx aE OF DEn,ry 2,wm .=� r_a..
<br />Kenneth Herluff Johnsen
<br />Male- 'November 23, 2001
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<br />e CR.ANCa BIRTH ,A,„<RD _ROAYNAN L
<br />5. AGE
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<br />DATE ..,a.. a. ✓A0
<br />6January
<br />"` DAY,
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<br />Marquette, Nebraska
<br />89eay
<br />20, 1912
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<br />EI DEATH
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<br />Hall
<br />Grand Island
<br />1407 W 16 St. 68801 .,,ENO❑
<br />10 RARE III WEA,
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<br />White
<br />Danls�
<br />Norma Hansen
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<br />s Eo0 NT .azw . ND OF BUSINESS INDUSTRY 'TREATED SUARD orfl$ LAND! gFId' LAW "S
<br />a op =. <Aa
<br />�Manager
<br />office REA Rural Electric) L 12 -
<br />IL, 16FA,AER.NAME UNIT MIDDLE LAST HI — F�RPena �" "` =ucxAMF.
<br />MAIC EN
<br />Mike Johnsen Sena - - Jensen
<br />HonA n� "n. f .m.R a .an, n ""Y" "'ads Norma Johnsen
<br />Ab NO.EMANT MARES1DORSC, N RFD NO. DRY ORTDWN STATF OP —-
<br />407 W. 16th St., Grand Island, HE 68801 _
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<br />Hi_ Mort Pry, Inc. ❑- =m =b,❑ ^_ Kronborg Nebraska
<br />ne ury M AoDRn S -RFe OR T✓ 5USES . A nPJ
<br />�. EaA�YO F - C o
<br />Box 204, Aurora, O NE 68818 -0204
<br />zr wMEDATE CAUSE RNTPR Oxv ONF CAUSE DEL LINE FOR �d, AND 0' — ='S ,—A. EL, .YET
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<br />DATE A: 1 -Dnx"I YOUR 0' wuxr vosnmo -`Y AT'
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<br />— ° DAYEDFD�,TY ,MR �. ✓„ Z ,Na DATEE�ONED .N "1 ✓,
<br />as November 23, 2001
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<br />Y 27bDATEAIGNED DNO IM ni DMEOFOEn N &„F, z& PRONOUNCED DEAD UR D =y. n, ✓UA PPONDUNCF —RED PAR11
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<br />DID TOencca DSFGO.A�•
<br />N .nNn� rN �•��xaws CONSENT GRANT
<br />zR TRiaUre rDTRF OFATn, >o =YASOaonN OR TISSUE OONATiON FFN CONSOEaFD• E�,
<br />❑ "I NO ❑ TRENDIER 2 'ED ❑ ND ❑ YL, k ND
<br />Lot Two (2), in Block Four (4), in Park Place, an Addition to the City OF Grand
<br />Island, Hall County, Nebraska.
<br />
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