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<br />STATE OF 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 RECORD ON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA7"l~~~-'.-WHICH IS <br /> <br />::;:::::~::ORY FOR WTAL RECOROS. ~!~ER <br />IVIJ.\K 1 0 2006 20060 2309 ; ASSlsiANrsiATE REGiSTRAR <br />LINCOLN, NEBRASKA H'fAttHANDHUMAN $E;RVfCES <br />:-:' ~ -~- <br /> <br />STATE OF~ - DlPARnIINT Of HDUM ): ";::''i~O~A~~' A <br />MlMAUor:VlTAL~ATlITICI " ",~,_,,} ,'"I:M.1 1171'9 <br />ClflTlFlCATE ()If DEATH '" ',. --_', =-"_:'"- <br /> <br />1. <br /> <br />-IWIE <br /> <br />T <br /> <br />MIOOI.E <br /> <br />LAST <br /> <br /> <br />Delbert <br /> <br />William Kenyon <br />5,L AGE -... ~ <br />IV".I 511. MOll. <br />76 : <br /> <br />CAYS <br /> <br /> <br />c;:a.stana, Iowa <br />7. 8OCW. I!CUIlITY ~ <br /> <br />\l. <br /> <br />... ~ Of' llEATti <br /> <br />I ~ <br />/II......... -lINe __ W """-I <br /> <br />..t!lllieII&.: 0 ...... 0 EA/~ 0 OOA <br />JmIfB; Xl HutainO _ 0 _ 0 '** ,.,..", <br />k. CITY. TOWN OIl lOCATION OF DEATti Id CtJY.......... <br />- ~~"'NllI_ <br />St. _Francis Memorial Health ceo Etr GrCllldIaland _. <br />-a ~ . STATI! lie. CITY, TOWN OALOCATlON <br /> <br />-508-01-0900 <br />.. fACiirv . _-- <br /> <br />Nebraska <br /> <br /> <br />Grand Island <br /> <br /> <br />Ball <br /> <br />10. MCI! - ... ..... ..... __ -. "- o\HCESTAV ,..0......... _. 0.-. ..) '2. MAIIIlIED,fIlF.VEIlliWlllEO. <br />...~l1Tte (~rican 010 ~~/fJld1I <br />,4& -lJi!UA[ OCci.IPATlON IGNI_ aI_ - during - 'olI> KINO Of' 8U8lIESS INDU8TlW - 00 <br />aI-CCXidu~~ 'l/~ nion Pacific Ra~lroad <br /> <br />'e. FATHER. _ FlIiSf .----aiiOoI.E LAST 17. WC7lltEA. MAlDEN IIlME <br /> <br />Willlla Belie! <br /> <br />Arthur R. <br /> <br />it: WAS DECEASEO fVER ... U.S. AfUED FORCES? <br />. IV'" ..... or unt.1 pi YII, giwe _ IIlIl _ Of ..mc.1 <br />Yes: 1 2 10-30-45 <br /> <br />-- ..-...~~ <br />DonlIIion . <br />Bur~al <br /> <br /> <br />u..........,....ut : <br />...,. llIIlClU!' <br /> <br />~CJ.4 . <br /> <br />(Mr <br /> <br /> <br />Wilma Kenyon-230 s. <br />201:. CEUETl!AY OR ~TOAY . ~ <br /> <br />Lucy Stark <br />OR IU' .o.lC)., arv OIIl(M1l.-"'A 2I"l <br />Grand Island, HE. 68801 <br />arv 0A1OIIIl STATI! <br />Grand Island/Nebraska <br />iSTMEfOR MD. fIIO. CfTY ()fI TOM!. STAlE.., <br /> <br /> <br />fe1--Butler-Geddes 1123 W. 2nd, <br />(ENTER ONlY OllIE CAUSE PER LINE FOR 101.11II. AJlO fell <br />cd! ~~~_. ~ ~~~ <br /> <br />GrandIsland,RE.68801 <br />I ......................... <br /> <br />: 7' /1~"'~ <br /> <br />, ...............--.. <br />I <br />, <br />, <br />~ "-""~--- <br />t <br />I <br /> <br />.11I _. _ .. _ __ _ . <br />DUE TO. oR' olS AtoHsa:lueNcE Of': <br /> <br /> <br />__ 10 <br />_ClRCllIOlI!II? <br />~ -.."" - <br /> <br />... AT WOfIK <br />ISPfdIy Y. (II NeJ <br /> <br />.. PLACl; OF INJURY. A1-. iw"" __ ....,., <br />..... buIIdInQ..... ISiJ<<;Iy/ <br /> <br />STREET OR A.F D. NO, <br /> <br />CfJYOR~ <br /> <br />_11' <br /> <br />27.. DATE Of' DEATH fW, OIly, Yr.1 <br /> <br />-- DATE SIGNED (W. 0Iy, YrJ <br /> <br />... 1lIE t:6- ClEATM <br /> <br /> <br />2111 """'MlI!D llbO ".,., <br /> <br />B. O. Urbauer <br />... IIfOIlI11lI.A <br /> <br />3Ob. WllS CONMNt GfWfIID? <br />CJ UNKNOVI/lIl CJ YES 0 Yl!S <br />AN. COAONIA'8 PHYllICM OR COUNTY AnOflNEVl "",.." <br /> <br />M. Grand Island, NE. 68803 <br />".OII\.TU'UIOev <br /> <br />t<<) <br /> <br />o YEll <br />31. NMiIf. NCI ADOfIUS <br /> <br /> <br />