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WHENTHISCDEYGRRES THE RAISED SEAL OF THE NEBRASKA HEALTNAND HUMAN SERVICES
<br />SYSTEM ITCERTFES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WRH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICSSECYJOREWHICH 1S
<br />THE LEGAL DEPOWIFORYFOR VITAL RECORDS.
<br />DATE OF ISSUANCE Jl
<br />6/17/2003 20031535fi Al A COOPER
<br />. AswsrANTSTATEREavTRAR
<br />LINCOLN, NEBRASKA HEALTH ANAPAIMAN SERVICE&dY&TEM
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND ffUMAN SSIol TBUNCRANO SIIPPO/Ryi�1. 06240
<br />CFRTIFICATF OF DEATH ,'. vv
<br />FCrnex?.xAmF REST WDDC axi
<br />I F%
<br />voniEOE OEAT11MaM. 0av veM
<br />Lloyd Robert Doehling
<br />n n,
<br />June 3, 2003
<br />a. CRT AND STATE OF pIPTX Rrrgn U.S4- nam,rnNN
<br />s<1 an9Wnv
<br />IEAS"1 YEAR
<br />IENE
<br />ri le OF Pmix --- I-
<br />AMarch
<br />Surprise, Nebraska
<br />" °'78 NMOSI
<br />mn
<br />XDOES
<br />12,1925
<br />- NisecuRTly xuMSER _ -
<br />sm
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<br />Tiffany Square Care Center
<br />❑ °OA ❑ °Nb °^" "'
<br />CITY .1 xOxwVADODUF nFwiX
<br />B1
<br />I !M COUNTY IF OWN
<br />Grand Island
<br />Inn
<br />a. PEwoENCE Sr.Te"
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<br />z ell TV: iowry IN LwATION
<br />Pa. WEEaTAxO UUMaEE nNF.aFwmwxl
<br />cz
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<br />Hall
<br />yip
<br />rn
<br />D
<br />'.'.'
<br />�
<br />;,1
<br />Er
<br />MEUSO"mlvhite
<br />IAFE�Y'x
<br />German
<br />DIVORCED
<br />Lucille E. Inselman
<br />Eli,
<br />EOI.—
<br />IAwm NVIgIrN."TREARil
<br />F,
<br />_
<br />IS FAT"EP NAME FwST Nl usT
<br />MOTxEE FIEST MIOCVP MAKER III
<br />Emil Doehling
<br />Maria Rathjen
<br />—I
<br />S s Cl EVEN U.I,,ARlO FORCESI
<br />% wroPA1ANT -HAIAE
<br />I
<br />Yes:1IIP12 %20/19441 11/7/1946
<br />Lucille E. Doehling
<br />I W. IN MAIL 1111-6 ISTPFFTM0.FD. XO.,CPY OP TI— ' -: Pal
<br />FDE
<br />1317 N. Lafayette, Grand Island, Nebraska 68803 _-
<br />u EMS.wEP- sr,NATUEEe ucExsExo. -
<br />z AMErrv000FDaPwnary
<br />zn. oAre— z
<br />�<. cEMEreRV On cPEMATnEY xeuE
<br />Not Embalmed
<br />❑a,.x ❑RANDII
<br />one 4, 2003
<br />Central Nebraska Cremation
<br />NMEN
<br />E VEMETFNVONCPFMATCMITICATION CIIVOPTCWX 9FRE
<br />Apfel- Sutler - Geddes
<br />®N•"ENT ❑DAeER,
<br />Gibbon, Nebraska _
<br />_
<br />P RRIFTEL"OMFAOmESS ISTEEET0RP .PO.x0- CFYORTPYNSIAF,ZF1
<br />1123 West Second, Grand Island, NE. 68801
<br />IMMEDIRECyAUSE
<br />PATT
<br />IENTEPOHLY ONE LAUSE FEP LIr F�Ox Ia101 ANOly1 Win LY Al m,x El SET
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<br />CD
<br />DATE OF DEATH (. DAY, v,)
<br />—
<br />iBt GATE SIGNED rMN -O.v. v.I
<br />E ae. Rl Of UEAIN
<br />June 3, 2003I
<br />CD
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<br />TMEOFOEATH
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<br />❑ YES I1(I
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<br />LOT TWO (2), WIESE SUBDIVISION, CITY OF GRAND
<br />ISLAND,
<br />HALL COUNTY,
<br />NEBRASKA.
<br />"AMEA"OADDRESS OF DESTINIES IEN- TICAH, COPONENSPxV9LMUOP COONIV AnOPHQYI IbgwFrnU
<br />880
<br />W. J. Landis 2444 Faidley Ave., Grand Island, NE 68803
<br />d,FILED
<br />WHENTHISCDEYGRRES THE RAISED SEAL OF THE NEBRASKA HEALTNAND HUMAN SERVICES
<br />SYSTEM ITCERTFES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WRH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICSSECYJOREWHICH 1S
<br />THE LEGAL DEPOWIFORYFOR VITAL RECORDS.
<br />DATE OF ISSUANCE Jl
<br />6/17/2003 20031535fi Al A COOPER
<br />. AswsrANTSTATEREavTRAR
<br />LINCOLN, NEBRASKA HEALTH ANAPAIMAN SERVICE&dY&TEM
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND ffUMAN SSIol TBUNCRANO SIIPPO/Ryi�1. 06240
<br />CFRTIFICATF OF DEATH ,'. vv
<br />FCrnex?.xAmF REST WDDC axi
<br />I F%
<br />voniEOE OEAT11MaM. 0av veM
<br />Lloyd Robert Doehling
<br />Male
<br />June 3, 2003
<br />a. CRT AND STATE OF pIPTX Rrrgn U.S4- nam,rnNN
<br />s<1 an9Wnv
<br />IEAS"1 YEAR
<br />IENE
<br />ri le OF Pmix --- I-
<br />AMarch
<br />Surprise, Nebraska
<br />" °'78 NMOSI
<br />mn
<br />XDOES
<br />12,1925
<br />- NisecuRTly xuMSER _ -
<br />sm
<br />IACEOF DEATry
<br />" °rvos ❑ "Palle" o'XE "- ® ..EN
<br />507 -20 -0645
<br />° "_
<br />❑ EE A.AAAl ❑ E•W"ue
<br />R FACIMtt alma rynwons— pw ANNE-1 nrvW
<br />Tiffany Square Care Center
<br />❑ °OA ❑ °Nb °^" "'
<br />CITY .1 xOxwVADODUF nFwiX
<br />B1
<br />I !M COUNTY IF OWN
<br />Grand Island
<br />YAA R N. ❑ Nall
<br />a. PEwoENCE Sr.Te"
<br />acouNTV
<br />z ell TV: iowry IN LwATION
<br />Pa. WEEaTAxO UUMaEE nNF.aFwmwxl
<br />s.. wswealYl!wTs
<br />Nebraska
<br />Hall
<br />Grand Island
<br />1317 N. Lafayette
<br />Y- EJ NE ❑
<br />Wrvu. 94q. A.A. —PCwn
<br />I I ANCFS* YIAq. Ella. Me.¢an...IT- -1 --
<br />?::O MARRIED ❑ WIOUWFO
<br />N AMEw'SPUUSE / we.I AmALUniv I
<br />"
<br />MEUSO"mlvhite
<br />IAFE�Y'x
<br />German
<br />DIVORCED
<br />Lucille E. Inselman
<br />E.
<br />USUALOLCUPATIW /CrwYNdwxmv d+agmw "MOCFWYNEUmuu9[ —
<br /><.✓.r,r!.r.PMAN.rrum
<br />aGeneral
<br />EOI.—
<br />IAwm NVIgIrN."TREARil
<br />N..rr s•PN++.ry m -�A c.ES•x+dsl
<br />—
<br />n�
<br />Carpenter Contracting
<br />IS FAT"EP NAME FwST Nl usT
<br />MOTxEE FIEST MIOCVP MAKER III
<br />Emil Doehling
<br />Maria Rathjen
<br />—I
<br />S s Cl EVEN U.I,,ARlO FORCESI
<br />% wroPA1ANT -HAIAE
<br />I
<br />Yes:1IIP12 %20/19441 11/7/1946
<br />Lucille E. Doehling
<br />I W. IN MAIL 1111-6 ISTPFFTM0.FD. XO.,CPY OP TI— ' -: Pal
<br />FDE
<br />1317 N. Lafayette, Grand Island, Nebraska 68803 _-
<br />u EMS.wEP- sr,NATUEEe ucExsExo. -
<br />z AMErrv000FDaPwnary
<br />zn. oAre— z
<br />�<. cEMEreRV On cPEMATnEY xeuE
<br />Not Embalmed
<br />❑a,.x ❑RANDII
<br />one 4, 2003
<br />Central Nebraska Cremation
<br />NMEN
<br />E VEMETFNVONCPFMATCMITICATION CIIVOPTCWX 9FRE
<br />Apfel- Sutler - Geddes
<br />®N•"ENT ❑DAeER,
<br />Gibbon, Nebraska _
<br />_
<br />P RRIFTEL"OMFAOmESS ISTEEET0RP .PO.x0- CFYORTPYNSIAF,ZF1
<br />1123 West Second, Grand Island, NE. 68801
<br />IMMEDIRECyAUSE
<br />PATT
<br />IENTEPOHLY ONE LAUSE FEP LIr F�Ox Ia101 ANOly1 Win LY Al m,x El SET
<br />{IXE
<br />CuEttI,OP A6 PCOH5E0UENCEO In qM
<br />IeIOU[iO.
<br />OPASA CO.FEOUE MarvLmwenman.ne wun
<br />NCEC£
<br />E
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<br />'CI
<br />ART FFI FEMALE WES TxEPEA NAUTOPSY
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<br />❑ N m. nSTRYN
<br />YEE ❑. Al
<br />DATE OF DEATH (. DAY, v,)
<br />—
<br />iBt GATE SIGNED rMN -O.v. v.I
<br />E ae. Rl Of UEAIN
<br />June 3, 2003I
<br />Y
<br />Cr
<br />OATESl (Ah. yYrl
<br />TMEOFOEATH
<br />,E9:30
<br />]GCE ] ONOE00UO I.vo 'NY YrI
<br />:ed PFLNOUHCE00E.D lvMn
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<br />m.. orrlre IN OF eF_ STA., EIRANA
<br />R,NE.�ARESSES IFa.WI..a1
<br />e.. ur. wn
<br />�J C$
<br />.o _ FREE Sl w E`AAEE
<br />=wwa.�n.I. ti12
<br />HSDFHEO?11tla _
<br />ze. III TOeACCOUIECUx
<br />euTEroTxEOEATXZ .'ea
<br />XAS OR(1AH 'sue UCNATKKI RE EN
<br />ID WAS CONSENT DRAFTED?
<br />O
<br />o I]VryCI
<br />``�� --..//
<br />❑ YES I1(I
<br />W
<br />YES ND ❑ u.FNDWN
<br />YES
<br />T
<br />"AMEA"OADDRESS OF DESTINIES IEN- TICAH, COPONENSPxV9LMUOP COONIV AnOPHQYI IbgwFrnU
<br />880
<br />W. J. Landis 2444 Faidley Ave., Grand Island, NE 68803
<br />d,FILED
<br />�.
<br />n PEGIW.
<br />a:a DATE BY REGISTRAR 3 vq
<br />NLM
<br />JUN - 5 2003 --
<br />(C�1 \
<br />
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