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<br />WHEN THIS copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES <br />SYSTEM, "CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH <br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA TlSTICS ~J$I;T.lOI!,---wt!1C;tlIS <br /> <br /> <br />:TELE;~'::::ORY FOR WTAL RECORD~ ;Jt;IjJY;.!fl'~ <br />LI~~OYN,ON~B~~~ 20060 7 5 8 5 HEALTH A~~S~= :~C~W~= \; <br /> <br /> <br />(" -":" <br />-- -, <br />STAn: OF NEaJASKA. DEPAJt.1'MIlNTOF BEAL11f ANDHVWAN SEaYlCa F~JtiiftJu~;' _. <br /> <br />CERn~~~~EAm "",..-..gS.'=-!S019 <br /> <br />CEDE"T . _ FIIIST MlOOl.E ....ST 3 DAfl 06 DUn.- __ tlOo y_ <br /> <br /> <br />ecelllber 6, 1999 <br />. DoAlEOI'.""" _ ._ <br /> <br />Edward Henry <br />.. CITY oUlOSTATE OF llIFIf" 1,,,.,,,,U5A _~I <br /> <br />507-28-3534 <br /> <br /><?~'" <br /> <br />Se t;ember <br /> <br />0-- <br />D-- <br /> <br />o 0.,.. J$p9<"", <br /> <br />14, <br /> <br />1926 <br /> <br />ROSf!,__.}le br as ka <br />1 !lOCw:.SEc\JA11Y.....-~ <br /> <br />.. I'lOGE 011' OEAT" <br />~TAl. fi- <br />o III 0.- <br /> <br />0000 <br />I <br /> <br />k C1~::OC::'::~, Nebraska !~ :ij:O I:~OI'OEA~ <br /> <br />Ie I\(SIDtJ<<;E.STAlf ," COOHTY k e"y fOO/t<ORUJe"TiOh .. S_fToUlO",-A _z",c-I .. l.Yft <br /> <br />Nebraska ! Hall .--JGrand ISl.and _k203 Ba~s Rd. 68801 I ,.5?J-O <br />'O::'S:~I-llIo<o<-- ]'" =~"""'--i--' I'JfJ~ DoIiOClO'oWO 11-'3_OI'lI'OVSli ,,-....-- <br />_Whi te.. Amer can _ i D~~ DlllYOI'ICiD Grace Reinecke <br />,..'USiJAL Occui>AToOoi _ _.. _ __ _ I'''' 0<lI'lQ 01' "'-'-IM>U$- i .. EOucAlION . ISIooo>tr"'"'......-......... <br />~",,,,"..I-.a1 I 1 ~O'~tO,'2I e...a.li"'(JI~"l <br />18 FATHfIl._ S~ervis~E Far~T Machil,",~ Manu!,:..! 8th~"dllrO IlAUNIUIlfrIAW <br />i <br />Nee.an 1 Velma <br />j1"~.""'" <br /> <br />.. FAC..,Tv ':NliNO~~~~~..-' <br /> <br />_ f'J(Jf ~ gww I#INI MId riuI'tUrI <br /> <br />St.Francis Medical Center <br /> <br /> <br />A. <br /> <br />D. <br /> <br />Lonq <br /> <br />'.. <br /> <br />---- <br /> <br />: Grace Nee.an <br />D "" ClTV O!'! TOWOI SUTE lPi <br /> <br />2203 Bass Rd. <br /> <br />Grand lEland, Nebraska 68801 <br /> <br />20 ~.~"'UIIIf't.lCENiifHO ,;t,. Mf"~O-:C)IIIIOlfT~ Il"IlI ~'E-' 1 t"e CEMETfAYOR(:IIIIJEIM.TOf'Y NMII: <br /> <br />2h.~~~~m~lmed !D- O-!2~~~~22,~.1~T;,.ntral~ <br />Kleine Funeral Ho [j~ Do...-- ! Gibbon, Nebraska <br />l!'2I> FUIOaOAl~AOIlAl:SS ISTI!EETOP"FD 100 OhOfOT""" STOTt.", <br /> <br /> <br />~-._""".. <br /> <br />.................. .... <br /> <br />............- ...... <br /> <br />(0) <br />PAAT OT,*~ SiG-.cANT CON\lIfIONS. c.n-os _"'" - ~ ""'- <br />. <br /> <br /> <br />I aeo <br /> <br />o ~ 0 u-........ <br />o s..o. 0-... <br />0- '"_ <br /> <br />2lIb DATE OF INJURy 14lo 0.. vn I ~ HOI;A OF ~.. <br /> <br />i'" lcu.'""" <br />I <br />I <br /> <br />ST'OUT OIl ~ F 0 100 <br /> <br />CI'TYOfll~ <br /> <br />StAT!' <br /> <br />.. <br /> <br />.. <br /> <br />~ <br /> <br />Center P.O. Box 9804 Grand Island, HE 68802 <br />l:a DoOTHUl>.... AEQlST1Wl ....lloo yo <br /> <br />i DEe 9" <br /> <br />/ <br />