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Exhibit A
<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 RE_, _- ON E (WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA TIST 15
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />D ► S
<br />Fj UAI1(� r/ AI1lLEY3 4RER
<br />�� 2 08303
<br />LINCOLN, NEBRASKA 2005 a�sISTI115fT STATrA fFFlti/SR
<br />HEALTH AN(,? blIMIAAI �p4A�,li',I�YAT,�IN
<br />STATE OF NEBRASKA DEPARTMENT Of iiFJiLC�1 -7 J J!
<br />GUREAU OF VITAL STATiS78CS U V �'P L1
<br />CERTIFICATE OF DEATH = -
<br />r 1 OFCEDENT •NAME FIP jT �T�'•
<br />�' MIUDLF T LA57 -' .�
<br />r.mSEX .�.�
<br />_I i._C1pTE OFt DEATH
<br />Bernard
<br />Lyle Thompson
<br />Male
<br />March 19,19%
<br />= „1 A. CITY AND STATE OF BIRTH /nny�lU5A., rynt�[ wy/
<br />1 AGF. -am 9mFWy� u_NDER 1 YEAR
<br />�
<br />UNDER 1 DAY 6. QATE OF BIRTH rMwo Day v�.J '
<br />_ Friend, Nebraska
<br />;Yr, yp MD5 DAYS
<br />85
<br />5[ 40L)RS
<br />MIN5
<br />December 11, 1910
<br />a 7. SO�CI�ALpS@�CURT MBER IY NU
<br />ea PLACE OF DEATH
<br />�--1
<br />Suxatle >vr,Inny
<br />7,'�
<br />7 "JS•Z�17
<br />_
<br />HJSFITµ IrlpBllala
<br />0'. !ER F1 Nwsmgr15rA5
<br />t8b. FACILITY Name targfrrlslMypr, 5pYe 8dB:.IJnd rk nLwJ �~•
<br />F.R OLVabom
<br />�'J Rayder'cc
<br />411 E. Brookline Drive
<br />Ye4 Np ❑
<br />❑ nOA
<br />[} QW,
<br />- do CITY TOWN OR LOCATq]N QF DEATH
<br />Grand Island
<br />Bd INSIDc GITY bWTS ee COUNTV OF DEATH
<br />Yea Q NI, ®Hall
<br />9a RESIDENCE - STATE
<br />9b COUNTY
<br />9c CITY TOWN OR LOCATION 80 STREET AND
<br />f:LMgFU arcwwrp7p CaYel ! Sie W°+DE CTTY Lr.(TE.�
<br />Nebraska
<br />Hal!
<br />Gravid Island 411 E. Brookline Drive, 65801 Yp ❑ I
<br />10 RACE • wq, VA*P. dlfck. Amnrcan Man
<br />7 1 ANCESTRY le. o. "Akan, Mexican. Ganvmn• eiq 12 MAFWIED i N ^DOYrEO i 13 NAME OF SPOUSE rn w,rr 9w rwdrn,yr w1 Y
<br />lish D� Krehmke_
<br />_Evelyn
<br />14a. USI)ALOCCUPATION rune kptC(y wc: 'erne tavr� .,sf ..w_��...__ �..
<br />n9 142; KIND CF ?I'JR7NE39:NL1!y$YRY ! 15 EDUCATION ISpncaY _
<br />.11aaaaq Al,. arnaTrinaergYl !' I S•� 1 Elenre.ya7EOr
<br />' �
<br />= Uwner /C/peralor
<br />M.- _
<br />�' — 4 -W
<br />I Food bistribution Copan
<br />p y
<br />SocandYV 40 Co9agP ;1 aui•,
<br />1 L
<br />_��__�_�__
<br />� i8. FATNER •NAME FSt 't MIDDLE ___ LA -.1 `1 17 WTHER F1R.$`
<br />`_ --
<br />rpUJ7eF. 'J,AN]EN $:1/?'y�g1E _-
<br />Roscoe C.
<br />Thompson Urith
<br />Burnell
<br />- 18. WAS DEC`�,ASED EVER IN 4S ARMED :ORCE57 -�
<br />1R2 INF(RMANT,NAME ����-
<br />•� --
<br />- fYes. no. 7 urYl.) I IN yes. g” war and dal d eervrceal
<br />��!
<br />Evelyn Thompson
<br />186. INFORMANT MAILING ADDRESS
<br />i5THEET OR R D NO. CITY OR TOWN. STATE pPl f - ' -'�""'
<br />_. _. .,�,._......�,.,,_„_,•_,.,,,., T -_
<br />411 E. Brookline Drive, Grand Island, Nebraska 68801
<br />#1212 CAg T,al ❑ „
<br />Iaprel- Butler- Geddes Fjueral Home Cr malan Dn'a ar
<br />2213 FUNERAL HOW ADDRESS (STREET OR R,F D ND CITY OR TOWN. STATE 211
<br />1123 West Second Grand Island, Nebraska, 68901 -5899
<br />,23 MALIEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE
<br />PART yf'
<br />M I
<br />Y fi
<br />evil ir'C+ �(i��AC•
<br />WE TO OR Of A CONSECUENCE of
<br />i ;n1
<br />DUE TO CFI AS R CCt15FOUE^ICE
<br />1c1 -
<br />2113 DATE ._ 1216 Cf :MET =in iju CCw+:A7y�� .;yk� v
<br />03/22/1996 ' Grand Island �_wtv Cemetery
<br />21n CEMETERY CH rgcplA'TOpy l[a14.ATIOt :�'- '•---- `-yITY C*, TOJW ..�_� STATE
<br />Grand Island, Nebraska
<br />•a• 'nl ^''tD i!:,, Vow,al belrawn orlfM/�' }.• _
<br />y nelrti G . a�Elu ter, ,;.
<br />PART 5'GNIFICANT CCND!7K1tJ$ Conn:norl5 CJnI'Q
<br />uung Jn 1ne aeatr: but nd re131M
<br />I FART I-, Ir FEMALE '.YAS THEHE A ! 7= 4iI i t 15 Nf 5' A5E c£r'ERWED C NEDICiLL
<br />a
<br />I FREGNANC'IN THE PAST 9 MON, IIj'' i FK4MNaER51R L'L1rf>taC
<br />28a
<br />- -
<br />-- - - - --
<br />IA1gn In -5<I rata No )"- �T'as I Y5s Np
<br />�i
<br />Z6b DATE r rF !NJl1:1Y
<br />ifAr ;)aY Yr; E- HOUR OF fNJURY
<br />-E.
<br />28d CtSCA18E HOW IN.'URY K,= URRF.D� _
<br />nAcctlelM mrY___
<br />i
<br />�--1
<br />Suxatle >vr,Inny
<br />_
<br />�t_.. __�_._
<br />i
<br />! r-�
<br />285 IN,Ji /fvY AT WORN.
<br />i 51 T• ACE C;F m,�U?4T�P.1 " ~.- farm
<br />o.cv bu;k,•r,y, cic. cacrhl
<br />__�
<br />ege.1 1�.r;yy 2Eg LOCATION STREET ( ?.I R F D C17Y DR TOWN
<br />I �f HriA'nCd.• '•weslgalron
<br />Ye4 Np ❑
<br />r:
<br />12!i DID
<br />27a DATE OF DEATH tW Day Tr1 y _ ""•"` -` . ------ _ �22. DPTE SNiNEL �P,k• [I,f, .' 7BL f�
<br />March 196 1996
<br />Larch 246
<br />277 Tp i
<br />
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