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<br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES
<br />SYSTEM, IT CERnFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD. ON,ffL.E WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA T1STIC;~C;tltjN,~WfIJgIIS
<br />
<br />:::~::~:::::~TORY FOR VITAL RECORDS. _:~;~:'~:ifir{);j;~~~:
<br />APR 0 5 2006 336 9 ~ANLEYS.COOfiEltt
<br />. ... 2 0 0 6 0 ASSISTANT StATE iEi/StiiAR-'i
<br />LlNCOL.N, NEBRASKA HEALTH ANDHf'1A~RvtC~,~Y:~F
<br />~~'.. -;-'.,J;;i~~'tcJt~{:., iet')'
<br />
<br />I . ':. ,.::.:,;'..:;:'='.::::-
<br />JTAlEOF NEBRASKA- DEPAlllMENTOF HEALTH AND RUMAN SERVICES ~~"-W"':'~T
<br />VITAL STA11ST1CS"" ~.::-;",'o- ...
<br />
<br />CERTIFICATE OF DEATH
<br />
<br />, DECEDENT _ ~E FIRST I,IIDDl.E WT 1 SEX
<br />
<br />Ellen
<br />
<br />IDuise
<br />
<br />Lucas
<br />
<br />Fanale
<br />
<br />
<br />July 11, 2004
<br />
<br />15. DAtE OF at~l'" j~ Oil., V'HfJ
<br />
<br />. Dry ~NDSTATlOOFOIRTH ;,,,,,,,,US,~._"""""TI
<br />
<br />
<br />UNDER 1 VEAR
<br />51) MOS.: DAYS
<br />
<br />UNDER 1 DAY
<br />5<. HOuRS _$
<br />
<br />September 23. 1923
<br />
<br />Mason City. Nebraska
<br />. 7 SOCw.:.- SECUATIV Nut.lI8EA
<br />
<br />Nebraska
<br />
<br />Hall
<br />
<br />
<br />.. PlAce c.- .........
<br />~~ 0- OTl<ER
<br />
<br />DER~
<br />
<br />o DOl.
<br />
<br />ex .......""H""'"
<br />
<br />o """"'"""~
<br />
<br />o OtherISoec./hi
<br />
<br />. 507-24-1502
<br />
<br />
<br />III F4CllITY -_
<br />
<br />""",-...--..-,
<br />
<br />Grand Island Veter:
<br />lle crry TOi/t<OIH~1lONOFDEA""
<br />
<br />.. C<IIMTY
<br />
<br />Hall
<br />'" STFlEET AND """"Ell IW.~~'" CDMI
<br />
<br />,. '''SIDE crrv lI",T$
<br />I v..!iI.... 0
<br />13 1<AUE00SPouSE .'_ ..,......,.........}
<br />
<br />10 PACE-,_,_... a.c-. ~~
<br />
<br />d:f1SoKftt White
<br />
<br />1~ U5UA1-OCCUI'Al1OIiI :Gwlnfd~"~""
<br />dillCW"l.ng_....~~
<br />Homemaker
<br />
<br />
<br />fIIIlST -..
<br />
<br />Arthur Lucas
<br />,~ EOVCATION ,__ <_I
<br />~~..... .0.121 COI09O "... 0' .-.
<br />
<br />W\>O'-E 'lAIOE"SVIWAME
<br />
<br />Youn
<br />
<br />Unknown
<br />
<br />--------- Jim Lucas
<br />"-'-_55 .S'/'IIUTOI""FO 100. an'ClIl1DWO; S1A~ 2I'l
<br />
<br />j 2'1c CEWTEJW~CRf.U..lOG:~ tolM.ti"
<br />
<br />
<br />(.11'- ,)A f~
<br />
<br />Livin ston-Sondermann F.H. D~ D~ Grand Island. Nebraska
<br />I ZID <.--tOlIEAOlJOIEU o$tl'IEEtClllltFO 100 OtYClIlTDWW S1..n....
<br />
<br />601 N. Webb Road Grand Island Nebraska 68803-4050
<br />lJ .....l'ICAusf rEJf1'Ea:"'TOilIIE~PlII q,R'''1 ~ AHgJt~1
<br />"NOT
<br />',. Carcinana of colon wi. th ead bJ liver
<br />:lUt' TO 010 AS" CCl'Io!lDuEHOE Of'
<br />
<br />.......~I~~."'C~~
<br />
<br />
<br />'I>-
<br />"". 'Q OIOAS"~JoaClF
<br />
<br />.........I~on:w'I.I"(IiJi,;;.".
<br />
<br /><.
<br />
<br />~ i" Dl'Tt Of' IJUIIIlr ,... (lop'" .. "OulUlF OU/R"
<br />
<br />.............. &~~..... . r ~ ~
<br />'C ~ C ~ i*--UbAf...ofl)C
<br />
<br />y= -- - l v.O...O
<br />
<br />-;'~. ::'-T'i :o-:'DIEA~ ,,,,".0....,
<br />
<br />
<br />"NOT .." FE-.. W'~ THlEIlIIE A ,1< 'ull)PS'.
<br />.....~Y..D(..A!.T 3"O'/101S' 1
<br />~11l<,1oI1 v. n "" !XlI... n ...
<br />; _ Dlse_..ow_ (X;{.'-D
<br />
<br />
<br />".... OJwE" SlGlfECN(! CO'OfO'OS. ~_....._......_
<br />.
<br />
<br />'" loc.o' IOOf
<br />
<br />5'll11Ef'"",QFD 100
<br />
<br />r,n~ OM"()Wt.
<br />
<br />STA1[
<br />
<br />a. 041'1E $GH(:'b I~ lJh v"
<br />
<br />31> '''''' Of' !lEA'"
<br />
<br />July 11, 2004
<br />
<br />
<br />1:00
<br />
<br />ii! i 211< ~DEAD'" (Mo,'" ., "-OuNCEDDEAD ""'"",
<br />
<br />
<br />fl~ _0-...._"-_...,"'_"",,____.,
<br />. . ....- -_-..............~,-
<br />
<br />...
<br />
<br />130 ... ""'. SClM:I .. n.. .."
<br />;: ~
<br />~ f - 1" ~:::..:2,
<br />
<br />....t,WI,tUo"_
<br />~ -,-
<br />,.. ~,f~VSlCOOo1 lO'>'l1lfJl
<br />o ..~ B OC) 0 -
<br />
<br />...
<br />
<br />I JIl" WAS CDl4VI1 GlIA""ED'
<br />o..u
<br />
<br />[iI""
<br />
<br />3' __~OI' __(I(lIIIQIICOl~_OIOClIIMfYAnOlOOEV" ,,_,,-,
<br />I
<br />I Sheridan T. Anderron, M.D., Gr
<br />,.);>.>If<.o">_
<br />
<br />
<br />Hate, Grand Island, NE 68803
<br />)It> DATE FUD BY 1lIIE/lIS''''''R lit> tN, Yu
<br />
<br />JUL 1 4 2004
<br />
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