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200213310
<br />WH,Tht IS "CORYGRRES THE iO BE SEAL TRU ME NEBRASKA ORIGINAL RECORD.. ON
<br />THE NE R SKA H A THE BELOW TO NE A TRUE CORYOF THE ORIGINAL RECORD ON FLLE WITH
<br />THE LEGAL DE SNCOR AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION,
<br />WHICN IS
<br />THE LEGAL DEPoSITORY FOR VRAL RECORDS
<br />DATE OF ISSUANCE
<br />JUN 13 2002 ASSISTANT ANLEYSCOORER
<br />STATE REGISTRAR
<br />LINCOLN, NEBRASKA T HEALTHAN ,HUMAN SERVICES SYSTEM
<br />STATE OF NEEMSKA- DEPART hhtEN'I OF HEALTH
<br />STANDIIUMAN SERVICES FWANCE AND SUP[9RT
<br />VRAL SiATISIICS
<br />CERTIFICATE OF DEATH 02 06315
<br />FrcUa. -N.... "„ M. "RAF LAP, r—_.. _. _l, I.Ow,A,,, ,,,,U PAS
<br />,
<br />Larry James Friedrichsen
<br />Male
<br />May 22, 2002
<br />KEY ANDPTATE AT BIRTH lXUN.L5A KRHADu:wvl
<br />v HILL
<br />ES,
<br />s M w.
<br />Ivm
<br />HOURS "�"
<br />;rand Island, NE
<br />23
<br />JulY 26' .1978
<br />_
<br />OS<L SECURTN NUMBER
<br />AN PLACE OF DEATH
<br />ID ❑ "B- R ❑ "1A 1,
<br />i08 -15 -2768
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<br />RFBiDID/@ -PTAT
<br />COUNTS
<br />9eHall
<br />K, CITY TOWN OR LOCATION
<br />NU swEETANONUMBw :NT.erezoc�„ �o-
<br />4sIOEc TTOMFTS
<br />9ebraska
<br />Grand Island
<br />611 No. Eddy 68801
<br />Y.. ❑ NA ❑
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<br />u NAME OaNOUSE m.:wO mAbM NmAr
<br />NO' SW` " White
<br />I Isa�
<br />American
<br />ASIAN EARLIER
<br />Crystal Payton
<br />ISDALDDCUPAnON ACLAIXdwnam MnUSLARI
<br />uo KIND OF BD4NESb NDRITHV
<br />6 ENUWnGx
<br />'Saory onm mgnenga.emmRinml
<br />eIP...A'A s' ASADA 1
<br />a•w,.:re.me AM
<br />Laborer
<br />Construction
<br />_
<br />10i0
<br />FATHER EARN FIRST .NODES LAST
<br />MOTHER FIRS M'DOLE MAIDEN SUHNAINE
<br />Thomas NMI Friedrichsen
<br />Lois NMI Goo
<br />40 Mrs- -crystal Friedrichsen
<br />.INFORMANT
<br />MMUND ADDRESS FUELS R R F 3 NO ANY UP LOAN. RUNIC AN -...
<br />ill No. Eddy Street, Grand Island, NE 68801
<br />.s s o IA N.TRwoF Disrasmox re DATE ceMETSR.oR CREMATOR
<br />NAME
<br />GN ypedL M a (aska tlORSPSV]
<br />AN-I 1251 P ❑B„ ❑R.m ,� May z9, 2002 Central Nebraska
<br />F rvaw HOMe -NAME rc ce.ETmv OR CRe.gTOm LorvTiON - -cin OR TOWN SAID
<br />3leine Funeral Home ❑X SA_ ❑DADDY Z Gibbon _Nebraska
<br />FUNERALEOMEADDRESE 'STREETORRFO.NO- CITY OR TOwx. PLATE ZEN
<br />3213 W. North Front Street, Grand Island, NE 68803
<br />EoATE wUSE 'ENTER ONLY ONE ER m11 ��« -
<br />MM CAUSE DN mANOnn ,, I ,,j,_ ,=T..,<
<br />P.R., 'kO�O-1'1 S (,44�\ i%Hm
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<br />ER SDN'RLANTGONDmOxS- OAdNmswu ningmx,.emNOM m.Nai Adr OP9 25 WASCASf REFEHHED IO MEDICAL
<br />HART
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<br />ON DA-FAI NATO -1 11
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<br />❑ m.N S11 AT 0 ❑�T;hr
<br />27, DATE MY DEATH ANAL TRY H)
<br />May 22 TAU DI -I AN
<br />D TOBACCO LSE CONTRIBUTE TO TIE DEATH HAS OR[.nx oR
<br />" ❑ ARE ❑ NO o DEATH,
<br />NAM CERTIFIER AN ODRDNECBPRYB'C,>NwRaNTYATTG
<br />EANDADD ��� TFE ' BG
<br />Dr. Van E. Vahle M.D. 250 No. COlumb-
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<br />R A,,, Fhu A I C`h" " RASAI T f�..r OG Sevwr
<br />3 v n So Mm 3 A?a &.e.,,I Y, h INI DEATH
<br />I ME OLDNOUNCED DEAD NO My LE 11 ISO 'LIKED FEAR 11 1,
<br />;7 �1SAR A
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<br />❑YS o NO
<br />NE 68434
<br />1:1 I'D o E.
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