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LEGAL DESCRIPTION: Lots Five (5) and Six (6), in Block Six (6), in Meves First Addition to the
<br />City of Grand Island, Hall County, Nebraska, excepting a certain tract more particularly described
<br />in Warranty Deed recorded in Warranty Deed recorded in Book 127, Page 37. ,
<br />G
<br />WHEN THIS COPY CAMWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERTFIES THE BELOW TO BE A TRUE COPY OF THE ORIGIMAi RECOR90N FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAMICS3ECTI0N WH►CHYS
<br />THE LEGAL DEPOSITORY FOR WTA`LIRECORD&
<br />_7 E
<br />DATE OF ISSUANCE Q o,3 V q-1 1-3 _ N
<br />������A7lIl�Y S. COOP R
<br />MAY 16 2003 ASS►STANT'STATE REGISTR
<br />LINCOLN, NEBRASKA HEALTH AN&HUMANSERVICEB•SYST
<br />4 STATE OF tftRASKA — DEPARTMENT OF HEALTH
<br />RUMAU OF VITAL SIATISMS - _- - ti ` +• V U O 7 V
<br />CERTIFICATE OF DEATP
<br />. IIAIrt T MIDDLE LAST
<br />� n
<br />Leonard D. Willman
<br />Male January 29, 1995
<br />TATEOF ORTH AFA7USA. Aby 0WVW S• AM . UNBKIO
<br />7C�,rand
<br />UNDER I DAY
<br />5 DAYS OF &RTH IAb1R FaeY.
<br />DD TTAYS
<br />Sc. FLDLIRS MN5
<br />I l m
<br />April 27, 1934
<br />NUNMHI
<br />505 -38 -7006
<br />2A PLACE OF DEATH -
<br />'!T!w ®" + OTHER ❑ KM%Nora.
<br />❑ ER 001III M% ❑ RM Ohba
<br />r F . N„W MwuIaWLM I @++eewtaAd .aPe,rF
<br />8t. Joseph Hospital
<br />❑ OOA ® d-IISO""
<br />C
<br />e
<br />Omaha V. CC Nb ❑
<br />Douglas
<br />°
<br />o�
<br />o
<br />r n
<br />9. NSGE CRY UWB
<br />Ci % t
<br />Douglas
<br />Omaha
<br />6111 S. 110th St. 68137
<br />c=
<br />z
<br />n. ANCESTRI Ja MNA MU Gw-wkee1 \�
<br />12 ® WHVRED ❑ WIDONkV 13 NAMEOFSPDUSE 10* rA AftW WM!
<br />White
<br />m y
<br />^� `ORcED Henrietta Rotherham
<br />Y
<br />P
<br />r-
<br />--+ M
<br />o
<br />-�
<br />ED EVER N US AIMED FORCES?
<br />IN MiFOFIMANT -NAME
<br />j w gc•e rot.sAddlra OlsbYIL�1953 -Henrietta
<br />Willman
<br />NAB2NSADORE55 tSTRIVETDRRFD NO_ CTTY ORTOMI. STATE. API
<br />6111 South 110th Street Omaha Nebraska 68137
<br />20. EMEALIAUL- SIGNATURE A L/.ENN NO IN& MERb3DGFUSNORMN
<br />21b DATE tIc CEMETERYORCREMATORY.NAME
<br />CL
<br />L�
<br />:� 2 a
<br />216 CIPMETEM OR CREMATORY LOCATIDN p7Y M TOWN STATE
<br />Heafev- Hoffmann- iAror_ak-Cu tler ❑"�°_° �°o"N"
<br />'2A
<br />Omaha. Nebraska
<br />FUb6TAL TAC"w•E ADDFIESS (STREET OR RFD NO CITY OR TOWN. STATE 2"
<br />3 7805 West Center Road Omaha, NE 68124
<br />o
<br />DUE TLT q$ ♦ �. yEpUE1q.F W, -,.•_ Imo- Mwtl UE wl wM nC MaFI
<br />M _
<br />DUE Tt?JR AS A CONSEOUENCE OF .— —... Mvwetrb..er!onsel ana AOIA�
<br />K!
<br />P Oi)iER `u�YFK.AAtT CONUITgNS Cerela;9 cnMAlpbTneoWreu nol*"d
<br />PART R IF FEMALE. WAS THEREA
<br />24 AUTOPSY FEFERRE
<br />75 WAS CA3E D TO MEDICAL
<br />PREGNANCY W THE PAST 7 MONTHS.
<br />N
<br />IAD.1..., 11.y n He
<br />Yas 0 N. Yba No ❑__
<br />ISa 2R1 DATE OF HAIRY Ab Day. Yr.l 2& HOUR OF FLUKY 2Fid. DESCRIBE NOW KIURY OCCURRED
<br />❑ AWdera ❑ UnpeNlr --w } M.
<br />122k
<br />11 S t cb Cl Wmvp MLAIR Ai WORK 2H PLACE OF CRY ly by p, 9— 0-IL aelpy 24 LOCATION STREET OR R F D NO CITY OR TOWN STATE
<br />ofcedror4 s/� w'wYl
<br />1 � H�a. ., � Y.• ❑ � ❑
<br />C-0
<br />Na DATE SIGNED !AEG Wy Y,
<br />2Eb TIME OF DEATH
<br />j�
<br />�- C 7
<br />0
<br />M
<br />rVb DATE SM3FiE0 rAb fle, 1yi c� ^r T.c ,'ALE OF DEATH
<br />r1
<br />28e PRONOUNCED DEAD 1+TG ft V0
<br />trn
<br />SP/ M
<br />8
<br />" �2Ba
<br />t` �J
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<br />?7A To ft, blNU xcwrAdMM1kM. A4ar+�p QUab
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<br />OA do% ALgWIjShlad. OeMb oeewn0al
<br />C4YR91 slmles %`
<br />WIYliis
<br />wa eaN A�sF W:�a am we%!ew ewtNSiwNa.
<br />W"anR!10 ft
<br />7
<br />IS. TAW 61
<br />DID TOBACCO USE CONTWJ1 TO THE DEATH ]D■ FIAS GR TISSUE DONATION BEEN
<br />—_
<br />CONSIDERED? 30D WAS CONSENT GRANTED'
<br />In
<br />❑ YES NO Q L%ApeCINN ❑ YES ..ErNO
<br />❑ YES .0--
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<br />CAI
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<br />200309743
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<br />LEGAL DESCRIPTION: Lots Five (5) and Six (6), in Block Six (6), in Meves First Addition to the
<br />City of Grand Island, Hall County, Nebraska, excepting a certain tract more particularly described
<br />in Warranty Deed recorded in Warranty Deed recorded in Book 127, Page 37. ,
<br />G
<br />WHEN THIS COPY CAMWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERTFIES THE BELOW TO BE A TRUE COPY OF THE ORIGIMAi RECOR90N FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAMICS3ECTI0N WH►CHYS
<br />THE LEGAL DEPOSITORY FOR WTA`LIRECORD&
<br />_7 E
<br />DATE OF ISSUANCE Q o,3 V q-1 1-3 _ N
<br />������A7lIl�Y S. COOP R
<br />MAY 16 2003 ASS►STANT'STATE REGISTR
<br />LINCOLN, NEBRASKA HEALTH AN&HUMANSERVICEB•SYST
<br />4 STATE OF tftRASKA — DEPARTMENT OF HEALTH
<br />RUMAU OF VITAL SIATISMS - _- - ti ` +• V U O 7 V
<br />CERTIFICATE OF DEATP
<br />. IIAIrt T MIDDLE LAST
<br />]. SE% 3 DATE OF DEATH &",m Day Yang
<br />Leonard D. Willman
<br />Male January 29, 1995
<br />TATEOF ORTH AFA7USA. Aby 0WVW S• AM . UNBKIO
<br />7C�,rand
<br />UNDER I VW
<br />UNDER I DAY
<br />5 DAYS OF &RTH IAb1R FaeY.
<br />DD TTAYS
<br />Sc. FLDLIRS MN5
<br />nmI
<br />Island, Nebraska � 60
<br />April 27, 1934
<br />NUNMHI
<br />505 -38 -7006
<br />2A PLACE OF DEATH -
<br />'!T!w ®" + OTHER ❑ KM%Nora.
<br />❑ ER 001III M% ❑ RM Ohba
<br />r F . N„W MwuIaWLM I @++eewtaAd .aPe,rF
<br />8t. Joseph Hospital
<br />❑ OOA ® d-IISO""
<br />a. CffV.. TLO�AMN LOGTON OF MATH - INSYDE CITY;IMITS
<br />- COLINTV OF DEATH
<br />Omaha V. CC Nb ❑
<br />Douglas
<br />t r RESOmICE -RATE
<br />!�
<br />® COUN/Y
<br />9c CRY. TOWN OR LOCATION
<br />9tl. STREET AND NUMBER (/rArgnp,}jo Coda
<br />9. NSGE CRY UWB
<br />Nebraska
<br />Douglas
<br />Omaha
<br />6111 S. 110th St. 68137
<br />w.$
<br />92L RAM •iaR.wMle &w-0. Arlr.ncln Now .
<br />n. ANCESTRI Ja MNA MU Gw-wkee1 \�
<br />12 ® WHVRED ❑ WIDONkV 13 NAMEOFSPDUSE 10* rA AftW WM!
<br />White
<br />"' C°dGerman & Irish
<br />^� `ORcED Henrietta Rotherham
<br />UPAT AamaTbwMaUIeIAYega•alt ��
<br />/Ab IDIIDOF0jS; Y*SS""TRY is EDUCATION �`-\
<br />Production De t.
<br />\��'! I EWn —n-- -t21 gy p. fs.aas•I
<br />Meat Paekin Company y u
<br />ME F'MI MIDDLE LAST I7 MOTHER FIRST ,MIDDLE MAVEN SIMFAAIE
<br />ries
<br />David Willman Deloris O'Neill
<br />ED EVER N US AIMED FORCES?
<br />IN MiFOFIMANT -NAME
<br />j w gc•e rot.sAddlra OlsbYIL�1953 -Henrietta
<br />Willman
<br />NAB2NSADORE55 tSTRIVETDRRFD NO_ CTTY ORTOMI. STATE. API
<br />6111 South 110th Street Omaha Nebraska 68137
<br />20. EMEALIAUL- SIGNATURE A L/.ENN NO IN& MERb3DGFUSNORMN
<br />21b DATE tIc CEMETERYORCREMATORY.NAME
<br />❑R. qoa
<br />2 -1 -1995 Calvary Mausoleum
<br />HOME -
<br />216 CIPMETEM OR CREMATORY LOCATIDN p7Y M TOWN STATE
<br />Heafev- Hoffmann- iAror_ak-Cu tler ❑"�°_° �°o"N"
<br />'2A
<br />Omaha. Nebraska
<br />FUb6TAL TAC"w•E ADDFIESS (STREET OR RFD NO CITY OR TOWN. STATE 2"
<br />3 7805 West Center Road Omaha, NE 68124
<br />2D . WtliAMTE _ 'i lP1EF Ial IsL AND (cp - ; PW�rY OASTwIn!wIaMCWr
<br />1 y/
<br />hl
<br />DUE TLT q$ ♦ �. yEpUE1q.F W, -,.•_ Imo- Mwtl UE wl wM nC MaFI
<br />M _
<br />DUE Tt?JR AS A CONSEOUENCE OF .— —... Mvwetrb..er!onsel ana AOIA�
<br />K!
<br />P Oi)iER `u�YFK.AAtT CONUITgNS Cerela;9 cnMAlpbTneoWreu nol*"d
<br />PART R IF FEMALE. WAS THEREA
<br />24 AUTOPSY FEFERRE
<br />75 WAS CA3E D TO MEDICAL
<br />PREGNANCY W THE PAST 7 MONTHS.
<br />E %AATNEA OR COFIONeq,
<br />IAD.1..., 11.y n He
<br />Yas 0 N. Yba No ❑__
<br />ISa 2R1 DATE OF HAIRY Ab Day. Yr.l 2& HOUR OF FLUKY 2Fid. DESCRIBE NOW KIURY OCCURRED
<br />❑ AWdera ❑ UnpeNlr --w } M.
<br />122k
<br />11 S t cb Cl Wmvp MLAIR Ai WORK 2H PLACE OF CRY ly by p, 9— 0-IL aelpy 24 LOCATION STREET OR R F D NO CITY OR TOWN STATE
<br />ofcedror4 s/� w'wYl
<br />1 � H�a. ., � Y.• ❑ � ❑
<br />( Sla DATE OF OEAT" JW Ow Yr.l /
<br />Na DATE SIGNED !AEG Wy Y,
<br />2Eb TIME OF DEATH
<br />S
<br />M
<br />rVb DATE SM3FiE0 rAb fle, 1yi c� ^r T.c ,'ALE OF DEATH
<br />r1
<br />28e PRONOUNCED DEAD 1+TG ft V0
<br />__
<br />29E. PFi�'IOUNCEO DEAD Pbw!
<br />SP/ M
<br />8
<br />" �2Ba
<br />M
<br />?7A To ft, blNU xcwrAdMM1kM. A4ar+�p QUab
<br />I+1
<br />OA do% ALgWIjShlad. OeMb oeewn0al
<br />C4YR91 slmles %`
<br />WIYliis
<br />wa eaN A�sF W:�a am we%!ew ewtNSiwNa.
<br />W"anR!10 ft
<br />7
<br />IS. TAW 61
<br />DID TOBACCO USE CONTWJ1 TO THE DEATH ]D■ FIAS GR TISSUE DONATION BEEN
<br />—_
<br />CONSIDERED? 30D WAS CONSENT GRANTED'
<br />In
<br />❑ YES NO Q L%ApeCINN ❑ YES ..ErNO
<br />❑ YES .0--
<br />31 NAME AND /1pME$g. . IIPNYiFCYM1.GY7FgNER$M1YSlCNN Op Lplylry ATTORNEY. !Types Fl.IC
<br />
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