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<br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, "CERTIFIES THE BELOW TO BE A TRUE Copy OF THE ORIGINAL REc.CJfP) Oil FILE WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA nsncs secnoN, WHICH IS
<br />
<br />::':o::=ORYFOR VITAL RE= .M..~;, ,f .~~
<br />MAY 2,0 2002 :2'0,0'" 6'1'0 Q '1:6, ,~,~':":iJANLEYS.COOPER
<br /><t)ASSlSTANT STAre REGISTRAR
<br />LINCOLN, NEBRASKA '... 'HEALTHA!IP HUIAAN SERVICES SYSTEM
<br />
<br />, OECEOENT. N....E
<br />
<br />STATE OF NEBRASKA. DEP AJl.lMENT OF HEAL 1lI AND HUMAN SERVICES FINANCE AND SUPPORT
<br />. VITALSTAnsncs . 02 05706
<br />CERTIFICATE OF DEA rn . , .', .' - . .,. .
<br />
<br />FIRST
<br />
<br />"'OOlE
<br />
<br />LAST
<br />
<br />2, SEX
<br />
<br />3. O"TE OF ClEATH '_.0., YOMI
<br />
<br />Peggy
<br />.. Cll'(ANDSTA.TEO~BlRTM 'IIno1~U.S.A..fJWM~J
<br />
<br />Ann Beswick
<br />So. "GE. LulIlil1hda, UNDER 1 YEAR
<br />tv...I 5 9 ~, IolOS DAYS
<br />
<br />Female
<br />'UNDER 1 DAY
<br />lie, HOUIlS "'NS
<br />
<br />May 14. 2002
<br />~ O"TE OF I\IRTH '_Ill" YOMI
<br />
<br />Alameda, California
<br />
<br />7. SOCIAL SECURTIY NU..BER
<br />
<br />551-62-5396
<br />
<br />eo. PlACE OF ClEATH
<br />HO!!flTAl. D-
<br />o ER 0ulp0Ii0nI
<br />
<br />DDOA
<br />
<br />August 22. 1942
<br />
<br />MeIISoec..." W hit e
<br />
<br />11, ANCESTRYI.,g..1Ia1lan. ........" _, Mel
<br />IS_"", American
<br />
<br />
<br />~!l' 0 N",""'I_
<br />lX]--....
<br />
<br />o 0Ih0< ,~,",
<br />
<br />8b ,^CIlITY. N..... (W""''''-'(Ji''_'''''_1
<br />
<br />309 Lakeside Drive
<br />
<br />II< CITy. TOWN OR LOC..TlON OF OEATH
<br />
<br />Id. INSlOE CITY U..,TS
<br />
<br />Grand Island
<br />
<br />
<br />r.. RESIDENCE. STATE
<br />
<br />Nebraska
<br />
<br />g" IN SlOE CITY U",TS
<br />
<br />Y.. [i] No 0
<br />
<br />13 N....E OF SPOuSE ,,_ """",......_1
<br />
<br />104." USUAl. OCCUP,4 lION fGN. Itind d lM;)fk c1oI'V t1UI'II'tf} moM
<br />allIIIOf.M'lQ _, ..~ t """.01
<br />
<br />Homemaker
<br />
<br />Domestic
<br />
<br />16 ~ATHe:R - NA"'e
<br />
<br />FIRST
<br />
<br />"'OOlE
<br />
<br />
<br />Jennie
<br />
<br />Span ler
<br />
<br />LAST
<br />
<br />11 t,OOTHER
<br />
<br />James
<br />
<br />18. WAS DEC SED EvER IN US. NWEO FOACES?
<br />f'l'ei. "0. Of ~.I /W ves. Qlv. w., and <Sa.. 01 MMceII
<br />No
<br />190. ..FORIMNT
<br />
<br />"AIlING AOORESS
<br />
<br />Tom Beswick
<br />ISTREET OR R.F,O, NO. CITY OR TOWN. ST"TE, llPl
<br />
<br />309 Lakeside Drive. Grand Island. Nebr~.ka
<br />20 E"_"ER. SIGNATURE & LICENSE NO 21'.lIETHOoOFIllSI'OSITI(ltj 2'1>. DATE
<br />
<br />68801
<br />21<, CElAETERY OR CRE.... TORV NAlAE
<br />
<br />Not
<br />
<br />Embalmed
<br />
<br />All
<br />
<br />Faiths
<br />
<br />Funeral Home
<br />ISTREET OR R.F,O, NO.. CITY OR TOWN, ST"TE. 21PI
<br />
<br />0-
<br />OOClomololDo-.
<br />
<br />0-.. Ma 14 2002 Westl.a.n Mem:ria1
<br />21d. CEMETERY OR CRE....TORY lOC..TION CITV OR TOWN
<br />
<br />ST..TE
<br />
<br />nil F"UNERAll-fOUe. NA.~E
<br />
<br />;12t> FUNERAL HO..E "OORESS
<br />
<br />Grand Island
<br />
<br />Nebraska
<br />
<br />
<br />2929 S. Locust St., Grand Island. Nebraska
<br />/J /J lENTER ~l Y ~E C"USE PER ~E FOR "'.IO~ AND 1<11
<br />
<br />~~~
<br />
<br />68801
<br />
<br />Inl8fVal between onset ~I\O oe.lI""
<br />
<br />I ~a.AZ
<br />
<br />~\I (InS4M al"l(l oe~rl'"
<br />
<br />101
<br />ClUE TO. OR "S .. CONSEOUENCE OF'
<br />
<br />tr-.."val Dtttween CiI"Iset ilnQ oea,'"
<br />
<br />1'1
<br />PAm OTHER SIGNIFICANT CONDITIONS. C<>>ditiono ~ 10 1ho do... b<Jf no! 'tIolo<f
<br />
<br />.
<br />
<br /><160
<br />0 ~CiOe", 0 IJI'lClO:l8fMtfte(l
<br />0 s..e.,. 0 Pendll"\Q
<br />0 -.,. InveSI19allQn
<br />
<br /><'60 O~ TE OF INJURy "1M<> o.y. Yr,1 ~ HOuR OF INJURy
<br />
<br />
<br />2119. UOC" TION
<br />
<br />STREET OR R.F,O, NO.
<br />
<br />CITY OR TOWN
<br />
<br />STATE'
<br />
<br />2&>. INJURV..TWORK
<br />v.. 0 No 0
<br />27. O"TE OF OEATH (Uo..o.,. Y'.J
<br />
<br />210 0" TE SIGNED tUo. 0.., Yu
<br />
<br />2l1t> TI..E OF OEA TH
<br />
<br />
<br />fli I" ~ - PRONOuNCED DEAD tUo o.y. y,} 28d. PRONouNCED DEAD II-bKI
<br />
<br />
<br />
<br />~ a .. On.. bIf,W of ,.am.nMon and Of ~. In my opt'MOn wain OC:c~r~ aI
<br />Iho -. _ _ pIOe. _ _'" "'_'1_
<br />
<br />..
<br />
<br />..
<br />
<br />..
<br />
<br />30." WAS CONSENT GRANTEO?
<br />o YES 0 NO
<br />
<br />John A.
<br />32. REGISTRAR
<br />
<br />Grand
<br />
<br />
<br />This is a true and accurate copy of
<br />Peggy Ann Beswick, ~ {E
<br />
<br />Signed: ~;;V'/j /J {1 0lQ~ /A';h
<br />otary
<br />November 7, 2006
<br />
<br />the death certificate of
<br />
<br />Sandra Jean Budd
<br />
<br />GENERAL NOTARY. State of Nebraska
<br />SANDRA JEAN BUDDE
<br />M Comm. E . June 23, 2008
<br />
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