|
<br />(
<br />)"
<br />
<br />STATE OF NEBRASKA
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL,REGtJRD,QN FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA!"JST/{;SoSEC.ri{JN.,'{VHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ..~o~':;;- -~-~-c'c/3 i}/~--
<br />
<br />DATE OF ISSUANCE :. ,0: Ull7Q'" ==-
<br />MAR 1 4 2006 :' .' " tANLEY SrCpQPER
<br />20 0 7 0 3 5 7 9 'AS$.ISTANTSiAtEtR~tl/stRAR
<br />LINCOLN, NEBRASKA !/EAtrH AND Hl1M.4NSEIiVICES
<br />. -~~,~,,::,-,,'~fF .7-~.
<br />
<br />. ,~.
<br />
<br />r.CEC:~r.Oi"T ....wi'
<br />L
<br />
<br />~I. C:W..., ST~Tf or J1i;r..
<br />
<br />st"l11l 01 NDIIASK.A.-...U1YlNtOi'UEALTIt ANi) HIJNAN SIlkV1CllI1lf~~
<br />CEIt~~~EATH . ~_-'9 08737
<br />
<br />'W----I. se.---:-r,oATE"OFii€mi-;;;;;",o... V_I
<br />
<br />--fNl
<br />
<br />MOt\(.O.~
<br />
<br />.ftDt~ 1fM'_1tIttJ".""."
<br />
<br />~ ~ o1Y.lv 24, 1999
<br />10 _.._ _,.~,~ ~2!'!.'~ 6 '.......TEOf""1illm 1_0.. V_I
<br />fhot '" ~ "-IlMS 5<: ~ ......8 7
<br />@3-1.-__' Oct. ,_1915
<br />Ti. PLAt:f OF DEAT"
<br />I ~~ D _ Q!.",,~ 0 Nu<ooog-",
<br />DE....,........ Ci-
<br />o DOA 0 QIhw/$(JIc", -__
<br />
<br />.,_..l'ict.oda
<br />,':JI'ICI(".t,J$A. ....~
<br />
<br />..._J.:E'lMll.LltIlaM 5etxuJta
<br />,.,. r SOc:Lo4. SEc~1lV ~
<br />~
<br />... S()6..Q9..6623
<br />.i.... ,. ~i::"ff'Y . ~I
<br />
<br />3__204 W. 17th stnet
<br />~. ie t;rv "OWN f)$.1 ~OCATOto.l Of WTtf
<br />
<br />l ~~.~ . C~~TY
<br />I
<br />
<br />'0 AACE, ".~.. _ """ "'*'<:lrl _0.
<br />_,ll~)
<br />--- ~
<br />~ l~ USt..iA!"OO:UPA"'~ lGi~~Cf~ .......Gtriif--
<br />__ ~'~If.9_""'l1't~1
<br />~~~~
<br />~.5 fATHEII._
<br />OW
<br />1 Pete~ Victor
<br />.... '8 WAS OEtEASl!D EVER ~ U'C _tI fOllCES?
<br />
<br />~~! I. 'H~=~::~_l
<br />. ~Street, Gland
<br />LJAEH . 8I(l""TUAE . uce~l: NO
<br />
<br />
<br />e. CO\JOlTYOF~TH
<br />
<br />FJIS'i
<br />
<br />Ball
<br />-rRt1IITANi)''''''ae~ 11n<_Z-",~/
<br />
<br />---RQ4 W.. 17th ~..
<br />I 11 [j_n 0 WlOOWIiD '3 NAlolE OF lIPC<IS~ ,'.....",..--
<br />
<br />L- I D~.' 0 tllVORCEtI williR B.. UdIoff
<br />,.., <<lNIlOFllU8WEIlS"'IlVStR.{ i 's. ~O\JCATlOi< :'1;ooooly!"IIy"~__
<br />I ~-....y"'.;.~'O"~l ~"-,,,,.,
<br />ie l.u
<br />17 -..oTHER ::IRST "'~
<br />
<br />I .. ""'lIDl' C1TY UWIS
<br />I
<br />68801 iv-Ill "" 0
<br />
<br />lII(lOl.E
<br />
<br />LAST
<br />
<br />
<br />1iAlllf.N llLJIIIIlAMl!
<br />
<br />Cathel:Un
<br />
<br />~ele
<br />
<br />1 William B. Q)boff
<br />'STIlEHOlll'.FD NO..ClTYOMTOWN.STME.lIPl
<br />
<br />
<br />IS]~..( ~
<br />64 · ~ lIl8PO!llllDl'
<br />[i - 0 Romo,..
<br />
<br />D~D-
<br />
<br />
<br />Park n-~
<br />STATE
<br />
<br />~. UN HOME ,lllDAEs. 1S1lIE<T OM RF.O. 0,0. CITY OM " STATE. ZlI'l
<br />
<br />-I..,) ....l"~!;;~ Stmet, Gr:arld Island, Nebr:aaka 68801
<br />~ f~"'TIR ~y OP<<: CAUSE PER l.ttE FCR fal iCl~ AHO 1f.:.11
<br />
<br />'PART ~
<br />jj '101 a:trA.' i'&-7 Clyy~
<br />=- OIJE TO, 011 AS A
<br />
<br />~. ~
<br />~_~L ~L':. . COII.a-"
<br />= ~7OM" ~
<br />
<br />leI
<br />PAA' OTHe~ SlOHR;.tHT COIQ"ClI.S ,~.,..,...;,..... _:it ""_
<br />.
<br />
<br />~;~~.~~
<br />
<br />h1iMH fes.
<br />!-..vll ~~.-lO""
<br />
<br />::t hv7J'J iA S'
<br />~~onHiah(lCNV'
<br />
<br />>eo I... 1)1;'" 0.........,. .... rw.- "'.1 ilk t<OI,Jft Oi'.......v
<br />o ..,,- 0 '-"--- !
<br />I 0 D.. I . -- .., \I
<br />SYC'IGI ~ .. ~"'tA:' .,.'.;~..". '* ~~\"~I;:f!J;f,bin':.stt..,~ 26g. LOCATION
<br />0- - 1 ...0 NoLl I ... ,
<br />\ I I
<br />
<br />~ s i 2" ;:~y~; 4~ ~ ; 99 .J ~ ~ [tI"<5~NED 1M> Wy YU I ~ 'MOFtIEA~
<br />
<br />~ I i ~ i>~Siiiii ~ rw.- y" 12.. ""IE OF DEATH Iii! "12llc: PIlONOV!'M;EtI DEAn ,"" Wy, '" I I~ I'AOOIOUtlCEO OfAO """",
<br />
<br />~JLI'~bJUIY 28, 1999 . 8:36 ~P... JL"'~i!!, i
<br />! ~ J EJ.7~ Ta.....bMdmyk~~~........~~~tM~'K)1hIt $~' ~ O;'Jmebafl,:;Jf~)lilI4;'If1I11;on.aN:tOfIlMlIlll'9*"',lnmyapinlOl'l-~~.
<br />g ~!:I~ ~./ ' $ thetl!i'l! "ilSi"'p!lIee~~toNca"ll.-.a
<br />""---___ ~T~~ ----H~JI1/) __L ~~fU"'T"':~_
<br />-La- [JIoO toeAC..uo 1.ISf.: COIIITAI8U'ft;.1M' ~ OAQ.AAI OR TiSSUE DOfItAtlQN UEi;N CONSIO:EAEO"1 . }300 WAS CON!:ENT G~Tet~"
<br />o VES ~"" 0 -. i 0 YES ,8J NO __ 0 ,ES ..c;r NO
<br />
<br />i"~':';"-==,~~. ""68803
<br />r qe~STAAR ~ _ ___ L tlAT:::AooTRAA 2ii
<br />
<br />I PA.~T ~IIF Few.tE wAS 1.-tc:f15 A ~ TI,i-,autOHv
<br />f'~'Er:iNANCY t;H THf; PAS' 3 MONTWS'" !
<br />,,-'O-"'! v.. 0 "" ~i v.. 0 ""
<br />2lIlI. tlESC_ I<OW INJu~y octUnIletl
<br />
<br />;os 'filS CiSf' !lEl'EAREll TO MEl)O(;Al.
<br />EX_" OM COIlOI<Ir..'
<br />v.. -, ...X'
<br />
<br />STAEHQFl R,f,l), tKi.
<br />
<br />Ot''fCATOW:\4
<br />
<br />.5T...TI;
<br />
<br />II
<br />
<br />II
<br />
|