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<br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERJACES <br />SYSTEM. IT CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECQRPONflLE WITH <br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM. VITAL STA'nST~~Et:J1!1,!.~CH IS <br /> <br />::~::::::::~TORY FOR VITAL RECORDS. ..' . ~~~, '~~~':~Ii~.~;--, <br />DEe 27 2004 20070636D~AI'W:.L~ <br />v A$"srANtSTI4TE'R~Gf$TRAR, <br />HEALTH AN~ $ERVic~~j$Y}rt'" <br /> <br />LINCOLN. NEBRASKA <br /> <br /> <br /> <br />- . : 0;=~.;~:!'L:,~~~~~t. <br />lTA'l1!OP"""'BA. "'Am8NfOlIflW,1BAJIl)IIIJMA)I_VDl~1NDII.IICiil+<~,.= <br /> <br />CB&n~~I;'~1H .,.,-~,~ - 03 01838 <br /> <br />~5U <br /> <br />flilff" <br />Janice <br /> <br />Kay <br /> <br />Female <br /> <br />1_ <br />" OIIYS lie- <br /> <br />23, <br /> <br />OTK1:l- 0-- <br />00- <br />o 0N01_' <br /> <br />506-66-5028 <br /> <br />"'.....-....-.... <br />3275 N. 150 Road <br /> <br />Cairo <br /> <br />Hall <br />fI1 $TlIHUNO_ (h;WItW~C/I<M '.-l" _CIh'~ <br /> <br />3275 N. 150 Road.,~8824!..::D__~~ <br />o lo1IIlOWfiP 13 _Of' $I'OUM 11I- (11IIII-'- <br />._LltllVORC1!D.1 Jame~..R..~~rkl~:l~w_ <br />15. EOlJGATlON .......... '._ <br />-rr*"lO-l21 lloIOIO ".....,., <br /> <br />~ iiMiii__ <br /> <br />... <br /> <br />10 <br /> <br />Verna <br /> <br />Mae __ Hellwesre <br /> <br />R. Perkins <br /> <br />Cairo, NE. <br /> <br />68824 <br /> <br />Apfel-Butler-Geddes <br />22b. F.-IGE ADIHSS lSTIlUt <br />1123 West Second <br /> <br />illJ.&." 00- 0-.. <br /> <br />O~[]- <br />.0. 110-. CITY IlTIl ZFI <br />Grand Island, NE <br /> <br />Feb. <br /> <br />21~ ee.w;TERY OR CREMATORY I <br /> <br /> <br />.Ie. CEWTeII'IORCl'ElllATOAV - <br /> <br />:!IO- UEll1OOO!' lll$lIOSlT1OOI 211>- 0..11:' <br /> <br />CITY <br /> <br />Grand Island, NE. <br /> <br />68801 <br /> <br /> <br />IIl';OII5EO.lEl<<lE 01' <br /> <br /> <br />- <br />~ <br /> <br />--- <br /> <br />- ..'" <br /> <br />a. IE Co\USl; <br />,., <br />I.... <br /> <br />. <br /> <br />'. lIS II CON$PlUEIIICli OF' <br /> <br />.. <br /> <br />:lItl 0ATt: 0I1lU.lRY /MD 0.,.. Wi IlIc MOUI< 01' llW"" <br /> <br /> <br />WASCI'SE_TO_ <br /> <br />~Jj~~ - <br /> <br />OTl1E'R <br />""'" <br />. <br /> <br />CONllITlOIIS. ~ ................._w""'_ <br /> <br />0---0-- <br />o - 0 -.. .. ....,..- liT_ <br />O - -- ~..o ...0 <br />I <br />OATE 01' OIlATtl 1M> _ VJ./ <br /> <br />STAI'ET OR RFI), NO --_..- '-';;:;',-(i':cwN"'''-~'-mn- <br /> <br /> <br />281 0." _NEO lMer.,"" yo <br /> <br />" ""iiilii-TiiiH--'-'---- <br /> <br />Zl'c. TQlEOfOllAnt <br /> <br />I~ @I 2lIC PRONOUNCEO DElIO ,... !lily. ../ <br />~ i <br /> <br />1I J i! ...Oo..._"'_.....-.....,.."'l'_.___. <br />~ ~ . ,.._._II1d.....""'..........__. <br /> <br />.... ~l)llEIID _, M <br /> <br />... <br /> <br />_ WAS COIlSENTGIWlTEO" <br />D YES [Q.--' <br /> <br />3' l<4...e IINI) IIlIIlReSS OF <br /> <br />M. Sitki Copur <br /> <br />Island NE 68803 <br />32b OATEFUllllVREFEB rr 2003 <br /> <br />.. <br />