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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A 'I:~U~ ~O_~'('1 " <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT..OI"H/!AL'I1I, <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPostTOR'l"'FOR: -',:-;,' <br />VITAL RECORDS, '>,: . " -';c, <br /> <br />J.At..J.... ~,~ A~~~," i~:, <br />AI1MW1f'4;~.'''f':r:~'':'/f~7 j <br />STANLEY S. CO(lPE~"Ii-Jlum'I'OR,; <br />BUREAU OF VITAL';~TATi:STI2s <br /> <br />DATE OF ISSUANCE <br />OCT 1 2 1988 <br /> <br />LINCOLN. NEBRASKA <br /> <br />DICtDINt-HAM' <br /> <br />STATE Of NEUASKl-OEPAIITlIIENT Of HEALTH 88- 10597 <1 <br />IUREAU Of VITAL STATISTICS <br />CERTIFICATE OF DEATH! <br />#Il1-OLf usr-'-"S!X- <br /> <br /> <br />... <br />InID!HCE - srAn: <br />"It. Nebraska <br />A _t.& <br /> <br />INSIDIClfYllMns <br />~~Mi"'te;H.' <br /> <br />Christian Thomsen Gladys Evelyn Jacobsen <br />IH'OIMANf-NAMf _.n....',ON5Hlfl_MAll1HG ADOIIU 111"11 011' D NO. CI"6'i1,rQ'r- .1.1.11. '1'1 <br />,Virginia Thomsen-Wife-1428 N. Huston-Grand Isrand, NE. <br />CIMlun01 CIlMATOllT-HAMI 'OCAn()frol (I"OIIOWH SlATl <br />K1c. Westlawn Memorial Park J(W Grand Island t NE. <br />fUNfa.., HOMI_HlUllIAHO AO~lSS linin 0...0 NO. ClnOlIOWH.If"".IIPI <br /> <br />,/lPfel-Butler Geddes 1123 W. 2nd, Grsnd Island, NE. 68801 <br />. A IN'...... D,. y", A 11 <br />~ai ... <br /> <br />Jh no'HOUHCIODIAO <br />M !eii' ~... ,n..,. v. I <br /> <br />Jig 0. ... ~...... ...._.... ....,.. ..........11.. I.. .... ..l"i.. ....... ..I......... <br />o!S .... h_.....Ie.... ,1....... ...... ".I..Mlol.-" <br />ul :l..fS....,.......,...,,~ <br />....nc.HUI"rp...,."".1 <br /> <br /> <br />68803 <br />I IIVI ,10ISlUI (M.., Dllr. r,., <br />OCT 1 1 li88 <br /> <br />: 1..._1.._...._......... <br /> <br />, <br />:"'_1..__.....11_... <br /> <br /> <br />Cd <br />,AIT "I ,.,tIt.ul COlCllhOHS~C....it.......In..................~I_..I..... <br />II <br /> <br />300. <br />lIUunA'~ <br />,~".._1oIooJ <br /> <br />CI"ClIIClWN nAn <br />