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<br />(!a-v<4' "-~ '~[ .::z;~(!td-vV ~ ~i-L-.&-rx'/ / /&-<:c. d" 7~ b""t..<,<~Ar,/
<br />WHEN THrS COP zt:ARR S THE RAtSED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A ~RUE COpy
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OFiHEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORYFbR
<br />VITAL RECORDS. ~"
<br />
<br />I
<br />
<br />DEe 161986
<br />LINCOLN, NEBRASKA
<br />
<br />jJs.j~II.J A ~,it ~ '
<br />/.J1~ . fAlVr-:/'
<br />STANLEY'S. ,.COOPER, ,D\1!:ECTOR
<br />r. ._' ,\
<br />BUREAU OF VI~A~ STAT1STICS
<br />
<br />DATE OF ISSUANCE
<br />
<br />.....
<br />
<br />
<br />STATE Of HEaIASKA-DEPARTMENT Of HEALTH
<br />BUREAU OF VITAL STATlsnes
<br />CERTIFiCATE OF DEATH
<br />
<br />88-- 100319
<br />82 10521+
<br />
<br />DECfDENT - HMAE
<br />
<br />"1ST
<br />
<br />"'IOOU
<br />
<br />J
<br />tStaUT 01 .. f D NO. (In 01 tOWN. 'TAll. liP)
<br />
<br />WAS DECEASED EVU IN U,S, AIMED FOlICEST
<br />1"". 1'10. Of ....!!) I (If yfl. ,i... -' _d do,," 01 .........(.)
<br />11M
<br />aU'IAl. Cr...tion. 1l.1ftO'I01 OAT
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<br />20<, I
<br />fUNUAI. HOME - NAM' AND ADD.lESS
<br />
<br />22
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<br />'. ~
<br />..~
<br />U~
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<br />...it
<br />iRA 2....'1./6 - ~ L
<br />.I~a: . PIONOUNCED DEAD
<br />
<br />.. .r;~i ~-S~pt'~) 11, 1982
<br />
<br />JA~ 0. .. IIMM .. ....iNtI... ~., "'~. i.
<br />:. 8, U .... tI_. .... .... .... .... cI__ - ., c
<br />.1_..."....,. v' 2....'Si_...........,. '.1 /I/t/
<br />CUT'F.EI (PHYSICIAN. COIIONEI'S 'HfS.C'AN 01 COUNTY AnOINEYlIJr,.. ... ',i.,)
<br />
<br />County Sheriff's Office Grand Island,
<br />
<br />DAn IECEIVED .Y IEGIST....II-,. Oar. y,.1
<br />
<br />HOUI Of DEATH
<br />
<br />24b.
<br />NONOUNCED DEAD (Hour)
<br />
<br />10:00 P.
<br />
<br />M
<br />
<br />260"",_1.
<br />27. '_iliA" ell>
<br />,.....
<br />:., Coronary
<br />DUE TO. 011 AS A CONSEQUENCE Of,
<br />
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<br />t.
<br />j'.
<br />
<br />2 . 5~t. M.
<br />IfGlSTIAII
<br />
<br />2&.
<br />
<br />'SEP -2 0 1982
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<br />"'.......1 '"'-- __..... .....
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<br />1........1 ~ -..t.lMI d.ath
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<br />,",
<br />DUE TO. 011 AS A CONSEQUENCE Of,
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<br />1..,-,,-1 ..~ _... .Ad .....
<br />
<br />
<br />,d
<br />'An
<br />II
<br />
<br />. SIO"-KAHT COHDmONI
<br />
<br />wAS CAst nfllltO TO MlDtCAL
<br />1J!.AM)N1I 01 COlOHII
<br />:;"i"hllW~e9
<br />
<br />_.
<br />HUI'Y AI W'l:*
<br />ts,..;f, Y. - ...,
<br />
<br />STRUT 01: 1.'.0 NcI
<br />
<br />CITY 0I10WH 'TAU
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