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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOR"AIJ1 -ILE WITH
<br />_
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICSSEGFJw_ IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. r
<br />DATE OF ISSUANCE _�
<br />e ANLEY & COOPER
<br />APR 0 6 2005 `� A!3ISTANTSTATEREGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES "SYSTE&I
<br />j*W&-MAW=ftW=tVZ=NhWW ,►ND- 279
<br />'M0F
<br />: eEx Maim -
<br />Bnnrsea�eg Bill l,aphay Mahe M+A, 2t8Q2 .
<br />Y Ar.a. e+ ,rNNf w �. Aeoc g11YS 5C No", 5.w jawary Z, 1940
<br />Vienti:mme, Laos
<br />OUT"
<br />555 --31 -0534
<br />ok f wt..r+ar.aaw,awra+c..ee.w © -
<br />St. Francis Meaical Center
<br />k' C V 6"1 CITY UwT� OR OF OUT"
<br />Grand Island wa ® Hall
<br />[j -
<br />■ yp COL&W 'x . Tom All i. XA"M
<br />Nebraska Hall Grand Island
<br />T6. •!r.¢W1Mi•�A,aM118nCAN�. TT AN( �$ TRYK .g..!l3AAiANtiM►ON1Tt11f1.YFi 7i ®1
<br />°%sue /American " Asian '
<br />TM l:9AALOC4YlEA IYIkMkMOiwY✓.dFMAMUiCw1d TMb 3(ylOOFNI>971ES & tAadiS
<br />w r,wwew i.aos Military.
<br />8nkitovu UnknC3WTl
<br />WAS EVER KO Ud G t!, qip 0*11NT -NAM
<br />iYea�6s+,wkf ! w,e,.5nwew�t6A��lfometoe K1amsao
<br />315 S'1111' Ma13 MO 68801 MOW J �
<br />rravrat+ to NAI>� � $44l>� #—#- ararte,m*up
<br />LrnOKEn 1Khamsao Pravixay
<br />15 evoc- T101n -
<br />S&I a
<br />CaWpe ItJdS•t
<br />LJ a7♦ a'aw �. ._ _ —. 31C G@N21pF'fT Wn 4,R,„w...�... .�..�
<br />• SlCilall ' Fl NO xiq q>(:TeQ6 \y7FO1pAAS1TtUr1 ' 2.L PATE
<br />J`kM�ay 25, _2002 Wellllw Memorial. Crematory
<br />i:u! GHaAETk'RY Op':W TORY LOCATION C'r OR TOWN �� STME
<br />A utter -- Geddes � � i Grand Island, Rebraska
<br />�. FLiNEAAL WO>aE ASb 7rT!AET O11 R6 a rot} Ctr+ C�iR TPyyli. $T'ATk _
<br />1123 West Second, Grand Island, NE. 68801
<br />_ wrYa1 aM..ea awM m+d artatn
<br />YMEpNT! 6".I0.YlE -- — �r "TER ONLY CJNE C 6$R 1,1 fC>r+ Est tbl. ATOP l[li .
<br />PART // ..xr a' w", �� r - ��V ✓�
<br />9a/'�4'3Y I .v"►. "" �..., 1rAprW dwaaw amr erto de.A+
<br />PVF76�(AIfASAC�lSE,�/I`.ktK �,us fr ° ��CZY� �'J' ` id% '�'�•• i
<br />PART ATW�R S1LMiF1CANT CA7H
<br />fBal
<br />•[CiODA ❑ LNG
<br />L1 tae
<br />a j%T0:V.* R A� A
<br />37C. OpYE SIDii�a6
<br />s7 bW Of rt
<br />Is lnr 0il>�tR CU-nA �AIIMQ I PART!
<br />Et w A` 4 rPnS
<br />MORTH51
<br />`M ••, —40" l• — 7tl6. DESCAIM NOW WURY C1CC
<br />Its OATS O� Y IA4, Clt7r Yr f ! A&• IKII)1: OF RI,AJiTY �,••
<br />N3J11[aY AT tAA7 _ .2S wA2&ft1wj .= +a +m .heel 4�c1pY ! mfl
<br />Ya5 © wo q
<br />27c TIME OF LWATM
<br />. n..e,m �x,we rfoe ww. dM" pwa And dtw to fAw
<br />YES �N[2
<br />0 uNetnuvaN �_
<br />F. AA!O AUUf1ESS OF CERnF�FJi IiYeYSt1:tAN, ,^.OR�:EpS pNY$iCMN C
<br />Jane McDonald M.D. P00_ N.
<br />fA9a 08y Y, i
<br />E]UMIr1f.H OR I
<br />� ko Yd1
<br />OR R.i D NO CIT Y OR T-
<br />t �
<br />vpONOt1NCEO OEAp /Ale Oily. Ye 1 2ld. PiiOrK7LMJLEO OEM /AAN•t
<br />M 'S 280 ..OA_ . r4" C0 QU;w =Mt1 v nvM0+9A9u^ x1 mY gNrwn lli7M' ace�aNd 1/,•.•^
<br />fies and ew 1e ate ssusMel 211
<br />L_ L LS!N1�
<br />ttlQ5L!E Cn'Y1A'T*N MEN COPS"; E07 764 WAS GONBENT OiIANTEOr
<br />YES �NO .� [j —YES �`!C
<br />(WEY. �rvpACr Wvur
<br />Ave., Grand Island, NE. 68803
<br />- dATE MAY Gt3 1 2002"
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<br />against Lot Five (5) ,
<br />Block
<br />Ten
<br />(10) ,
<br />Joehanck' s
<br />Addition to
<br />the
<br />City of
<br />_ rand
<br />Island, Hall County,
<br />Nebraska
<br />_.
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOR"AIJ1 -ILE WITH
<br />_
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICSSEGFJw_ IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. r
<br />DATE OF ISSUANCE _�
<br />e ANLEY & COOPER
<br />APR 0 6 2005 `� A!3ISTANTSTATEREGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES "SYSTE&I
<br />j*W&-MAW=ftW=tVZ=NhWW ,►ND- 279
<br />'M0F
<br />: eEx Maim -
<br />Bnnrsea�eg Bill l,aphay Mahe M+A, 2t8Q2 .
<br />Y Ar.a. e+ ,rNNf w �. Aeoc g11YS 5C No", 5.w jawary Z, 1940
<br />Vienti:mme, Laos
<br />OUT"
<br />555 --31 -0534
<br />ok f wt..r+ar.aaw,awra+c..ee.w © -
<br />St. Francis Meaical Center
<br />k' C V 6"1 CITY UwT� OR OF OUT"
<br />Grand Island wa ® Hall
<br />[j -
<br />■ yp COL&W 'x . Tom All i. XA"M
<br />Nebraska Hall Grand Island
<br />T6. •!r.¢W1Mi•�A,aM118nCAN�. TT AN( �$ TRYK .g..!l3AAiANtiM►ON1Tt11f1.YFi 7i ®1
<br />°%sue /American " Asian '
<br />TM l:9AALOC4YlEA IYIkMkMOiwY✓.dFMAMUiCw1d TMb 3(ylOOFNI>971ES & tAadiS
<br />w r,wwew i.aos Military.
<br />8nkitovu UnknC3WTl
<br />WAS EVER KO Ud G t!, qip 0*11NT -NAM
<br />iYea�6s+,wkf ! w,e,.5nwew�t6A��lfometoe K1amsao
<br />315 S'1111' Ma13 MO 68801 MOW J �
<br />rravrat+ to NAI>� � $44l>� #—#- ararte,m*up
<br />LrnOKEn 1Khamsao Pravixay
<br />15 evoc- T101n -
<br />S&I a
<br />CaWpe ItJdS•t
<br />LJ a7♦ a'aw �. ._ _ —. 31C G@N21pF'fT Wn 4,R,„w...�... .�..�
<br />• SlCilall ' Fl NO xiq q>(:TeQ6 \y7FO1pAAS1TtUr1 ' 2.L PATE
<br />J`kM�ay 25, _2002 Wellllw Memorial. Crematory
<br />i:u! GHaAETk'RY Op':W TORY LOCATION C'r OR TOWN �� STME
<br />A utter -- Geddes � � i Grand Island, Rebraska
<br />�. FLiNEAAL WO>aE ASb 7rT!AET O11 R6 a rot} Ctr+ C�iR TPyyli. $T'ATk _
<br />1123 West Second, Grand Island, NE. 68801
<br />_ wrYa1 aM..ea awM m+d artatn
<br />YMEpNT! 6".I0.YlE -- — �r "TER ONLY CJNE C 6$R 1,1 fC>r+ Est tbl. ATOP l[li .
<br />PART // ..xr a' w", �� r - ��V ✓�
<br />9a/'�4'3Y I .v"►. "" �..., 1rAprW dwaaw amr erto de.A+
<br />PVF76�(AIfASAC�lSE,�/I`.ktK �,us fr ° ��CZY� �'J' ` id% '�'�•• i
<br />PART ATW�R S1LMiF1CANT CA7H
<br />fBal
<br />•[CiODA ❑ LNG
<br />L1 tae
<br />a j%T0:V.* R A� A
<br />37C. OpYE SIDii�a6
<br />s7 bW Of rt
<br />Is lnr 0il>�tR CU-nA �AIIMQ I PART!
<br />Et w A` 4 rPnS
<br />MORTH51
<br />`M ••, —40" l• — 7tl6. DESCAIM NOW WURY C1CC
<br />Its OATS O� Y IA4, Clt7r Yr f ! A&• IKII)1: OF RI,AJiTY �,••
<br />N3J11[aY AT tAA7 _ .2S wA2&ft1wj .= +a +m .heel 4�c1pY ! mfl
<br />Ya5 © wo q
<br />27c TIME OF LWATM
<br />. n..e,m �x,we rfoe ww. dM" pwa And dtw to fAw
<br />YES �N[2
<br />0 uNetnuvaN �_
<br />F. AA!O AUUf1ESS OF CERnF�FJi IiYeYSt1:tAN, ,^.OR�:EpS pNY$iCMN C
<br />Jane McDonald M.D. P00_ N.
<br />fA9a 08y Y, i
<br />E]UMIr1f.H OR I
<br />� ko Yd1
<br />OR R.i D NO CIT Y OR T-
<br />t �
<br />vpONOt1NCEO OEAp /Ale Oily. Ye 1 2ld. PiiOrK7LMJLEO OEM /AAN•t
<br />M 'S 280 ..OA_ . r4" C0 QU;w =Mt1 v nvM0+9A9u^ x1 mY gNrwn lli7M' ace�aNd 1/,•.•^
<br />fies and ew 1e ate ssusMel 211
<br />L_ L LS!N1�
<br />ttlQ5L!E Cn'Y1A'T*N MEN COPS"; E07 764 WAS GONBENT OiIANTEOr
<br />YES �NO .� [j —YES �`!C
<br />(WEY. �rvpACr Wvur
<br />Ave., Grand Island, NE. 68803
<br />- dATE MAY Gt3 1 2002"
<br />M
<br />
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