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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD,Q)v FILE WITH THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTIC__*WICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. :. DATE OF ISSUANCE 2005 j j A O SEP 0 2 2005 1 L i7 ASSTS YT q. LINCOLN, NEBRASKA HEALTH ANDWUK4*SlEFt�71C $SYST6NC VTrALSr'AT4= iJ CEtRI FICA'lE± OF iDFA71 1 t�7�fi.AdA61¢ FNW WDOI ................__._— T � 2. SFiS�.4 9 �CM?E OF DEA711 AAw1((�. ►'�6T Robert Carlton Wolfe Male Maxch 13 2003 4. A OFA/ITH 10Q00..5A A ERM" 1 M - LTIY�R4T I VEAR UNDEA I DA a DATE OF!/TTH N41F1 1r1A7 tft t S1. MOS. DAr$ Lincoln Nebraska -- 7.5 _ - Sc. Ar/S June 4 1927 7 SDCIAL S0M^f r 0kGffR AA PLACE OF Bum 508-22 -6639 "'er"" ❑ ""."" °T ® mm"ilw" ❑ el 04sw ❑ R,prAn AC4TV -AC„r NAdrlAiip(pY.rAteyrwls1pr11pry verl 1r. Cny TOM di T" OF DEATH Or 1NEE7E LIrMTS M COIATV OF DEATH Grand Islsr-1 ! Ej Nr ❑ Hall 4 WROM - R—Aw 1tl STIIFATAND MASER Ar CaAn '% awzwi Nebraska Hall Grand Island 3303 W. 14th St. 68803 %w ® w ❑ 10. BALE- 1♦y,IMeL -OAP M.�KW /UW� -,- _ 11.ANCESTAVag.' MinC Qmwkmi 12 Ki MAFaw ❑woov ED 13 LIME M$0'%M N.*..IM�F,wrr now ""' White `�``"rican a,"RC><o I Wanda Mae DeMess 14 USUALO0M*AT0N 114b Moo 9U3wSS6*L6'I14w 1S. EDWAnM tBpWY.M Retired Officer � U.S. ,Air Force /Military - - -- - tM �9arF4/Y 10.12 coup 11.A d r•1 w _12th Grade - � N FATHER -MAW 1w1ST MOOLE LAST 7 1AOTkETI FIRST A1p(1LE lMID@lS111W41E "19-10 Carltala _ Wolfe � Leora Mary Davfg�_ , u WAS 61 US AIMED 119a. %IF(1NYIANT -N41E na+aalr+U 19T61.�a>ar9lgfisrrsnlarH69W Yes 10-26-1945L9-1-1968 a Wolf 116 POOirM4T MALMICi (STREET OR AF NO, CITY OR TOWN. STATE 11Ps 3 03 W. 14th St. Grand Islam Ns r ska 688 Zo SISNATURE a NO 216 LIETNODOF Duo, TON i 21A DATE 121f CENCTEAY OR CRERUTORY NAW ®DIIir1 ❑ prm w Mar. 17, 2003 _1 Ft. McPherson National 2191 CEME11ERr OR C:REVATORY LOCATION CJTr 04 TCRW STATE ZZA FUIEfiK - NAYE Liyin ston- Sondermann F.H. Maxwell Nebraska 226. RUNER4 HDW AOD11= TREET OR RF O. MO. CITY 09 TOWN STA 601 N. Webb Road, Grand Island, Nebraska 68803 -4050 7A. YipATE IENIEF OT6Y CAUSEPER1 ; ` eh luQ$ suspected*- i. -4. IA. C . OMTQORA',ACONSEQUENOEOF L7rWr.TwwlwNWF.eeR� 4 WE TO CA AS A CDWSEOun_f CE W ,•••• —� M.ra OIANrrn a� Ala wAF1 &7 PMT OT1ERSWCANT CONOrtO*- OMS%M d1W61AfflQ T76Y14rtl1ZANl"M PAR* 8d FEVkj WA51liEREa��2A AUTOPSY 25 WAS CASE RE F10 JED To MEWAL 1 i PAEGNANGV P9 THE PAS"..) RA *1M5T I,� *-D A NWR OR C _- 1 1Aq�p 10 -SA1 V66 F1 El 1 "- ❑ ft rr N. 7A. j M GATE 00 "AM Ab DAr 1"J Sac OR ftAp.Y iM DESCAkw How W&*,RT QCcIN.RD •• -- ❑ ❑ Suc1Ar ❑ t.rm WWV 2% LOCATw3h STRTORFRO NU WYORTOWW STATE a6r! .s�wcsY/ ❑ Hr.re.t. � Yp1 ❑ txr � ' ; 27A COTE OF DEATH Ob Dry ri! -- 'MR DATE 51CNw 1A6 Lbr V, TAE OF DEATH 2>6 474TE 91011ED Aft DAT n 1 7Te TMi OF DEATH —�� 20c PRC>waJNCEO UEAO .:1b Dry, n I IwR PgOWO1JW1;E0 dEAa AWM.1 �Zra Totl.prrtdlq aaearal +trot? MF (1r, FlC rpi dn01al w a IX*4 va "w n.1M �70+FLh AdA 4YM16,M IM Mq 6i6 671 G61t! rb Q1a q!M [al7Wf r1Mr1 CAY.Myi 1 �y NEnd Y1GT 4_ ',yy f �ryj� T ' 2! YJb TOMCOD IF9E ."OM.I'i7llS1E TL7 T+IE DEATH+ 1 Ma HAS ORGM ()R TtS$k1E R'.kM,nM KEN C.)kSCMO-+ 30b *As CONSEW GRANTED 1 L, ❑ YES PLO L4rtNCMnY i - ❑ rES 940 ❑ YES M) C I i✓� �— i ,�/ �3i WARE AND ADDNE.iS UR CENi1FiERiv/i`ISiC1AK CARp1ER5 srrTSiCdw tyR C:NWtY � ^ORNEr' �rwrv!'�rr .A729.— a>t— C- L1S.k-i. I..�—•7 LT `+ CDAA•] 173W DATE FEEDT"EGISTRATIr#o'IM1 I (` -- LIAR 17 2003