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STATE OF # g$MS%A - MAATM ENT Of HEALTH 87-100292 <br />#MAU Of VITAL STATI M$ <br />CERTIFICATE OF DEATH <br />_. NAA� "`_`.— Mme$- <br />«lfkvi iAT i$f5 DAFT ®1 D� ►PIt (A!s f?af r 1 <br />amale 1 March z0 1 <br />1 ,tea.- -_' •`^ <br />t ^{'� # '/ AR # S T igS `DATE #E #EH EM.. Dwf. rr <br />-" 1 '-{. atR. f!m[3, Aa r.6eR QiCrFN %OE$ ENT 4R 4 • EaaA M• .4aw. A,rE�- TNwr I (- ., -�„7_ E ..,.� -. - - -j <br />- fin 1 t MDS D}.Yb ♦SOU #$ HENS ; <br />Eerdh.w. ett.EdSpe.NN i +«w. a. >15p.1�F �� <br />3 <br />•, 41�- __.v...- ._...m.J.! 17 • w wow»} <br />�Y!! E/war ±w ET.$.A.. CtTa COUNT #Y.M#. NEVER MARPlEL. �}IAMI Oi4WE)!t ( Ni.. #.w wo <br />Maw+laalwt fd i (�IAOWEQ D#VC3RCEF#tSnK40 <br />_ hD arri (al i <br />USUAE.00CUfATlOt+l(G..e �rwdwYww.+l fwwed..wR waN ,� #9ND OE #U$tNE$50#INDUST#T iCOUNTY Of DEATH <br />t1 Y <br />- . �?a° C� (5�=rr. "erd�t1 c b Mad « � qr« Nh.E LM wd O wTdNU wF ebR e a+aNl s S i_af_UFt it }r N - Nas ai r O, <br />a <br />a ' <br />s� <br />C4TV, TOMN OtOCA ?i# K DEATH NSEIICTT NREFS KA <br />Se x + le <br />Island <br />TREfi AND NUM #Fi� i_ t�6aM$199E CITY i %Ma9$ <br />#FS/DENCE —STATE COUNTT CM, TOWN Off LOCATION aSp.e+Er ref e, Nei <br />,s. 'aiita �,sb. Hill T k _G3rand Island _;1$d _ 2 Weljt War ♦.� <br />I. A <br />MaODE —[ il+ MS}TnFR- MAIDEN NAM£ �. -8 � .*w LAj im <br />des. Stanl6� OlauAka ]�dqc.) Bells k._ -- <br />'STILL, O.. ' D !+D C O TO N. SaA f. LIIi <br />WAS DKEASED EVE# !N U $ ARMEO f(SKEST INEORMAN4 -NAME .ELAt NSH3t MAStING ADWE33 �� <br />t. <br />NO a Gera1d_ZalIow ki-H d-? L 1 � •- --�• <br />6URIA6 CroMroT+aw. Rowrowl -DAi CEME4ElT CN CREANTp!• -NAM£ tOCAi[ON CiTV O# TOWN $T/.iF <br />B�riai Yo.�8�i _ - _ S!Q.___�!# 1Dd 8t. Pa a.k - -- <br />- -- P <br />EM#AiM! #- SKrNATURf # LICENSE NO `� + s FUNERAI HOME - NAME ANO ADDRESS ;Sltf Ea Ot . r 0 NO. City O. TOWN. StAtf. Int <br />�DMAI"—.'. ,; ac sen Funeral Hasa 412 "0" 9tl. 9t. Paul. N�.- . DATE SEGED ,.. Dar Y, ' HOUR OP DEATH <br />° lab M <br />S-_ ♦ ...___._. - <br />-� Of <br />DEATH i P.ONOUNCED DEAD <br />HOUR PRONOUNCEDDEAp(nour, <br />:'^ OATF StONEO (AM, Owr. r• 1 - Lo. <br />. a <br />0. ¢E <br />f/ii A z 'Ind <br />4e rti !•w a F . ^••I•dY• d • tl a+ M• e+• d d +r• � o O x» A <br />3� �... e.. b n »r.i • •d <br />2}a <br />ANO A <br />NAME DWES$ a CERTifi¢# {WnY3KaAN. CORO*+ER3 vnr3K+AN OR COUNii AItORNEY: ;Trve <br />- r- <br />25 ay i R ro A .,'__!l.D . ll: {i TrT DATE RECEIVED EY REG57#AR IM Do,, Y _ <br />�IkEGISTW <br />Yea (SS I ►_. �- �'— �[/a.��':..'�.i. •.;. .. � -f Z i C '. -sad __ .n •i «rt__ <br />� N9ER ONtY ONE CAUSf WfR (INE EO! ). (b). AND 1 i "N•.w "•' °"' a d s <br />i <br />WART � fo w r Ft Y <br />' � R.OtJ •t5u CC <br />awe "� -�— - -- --- --- --- --' - - -- �' »•«i b.+..." •" »+. "a d «M <br />DUE TO, AS A CONSEQUENCE Of. <br />t•) . __._.._.__.__ -_.._ __ —.__ . _- ._.____._- - -__� i "+.non b.r..n. «»• o ^d d «tl. — <br />OUE TO, _.A5 A CONSEQUENCE OE. - - -- _ - <br />SEGe,HKAy1 CONOaT10a lS- Cewd• +w••.+ « +•9.• "q. »A••rr DU n• •• d tEG r CL lrli! �sl]MON1NSr SpW�i YW e• 1 ERAAMMrf p.1EnO CM"wEDiLAE <br />PART <br />IT � x • f/r s / a' E/ r NGL– le y 19 <br />ACCEDEMT, S{EKtOt. 1ply ;qit. Urapfi. OAn Of n.1ua; w. o•r. ,• , T�ou. Cri :N,u.t DEscnff NOW 1Nt Ufi occ ORffo <br />AC EE.K.!!i NH•lSTEGATror! five 11 <br />0 <br />m. I t,LNLs S we s <br />O —Y <br />- <br />- L WEAGF eH1U.Y - .. .. •. �OUr10N s-[!ta . I s D Ne CITY . Tow. STA <br />M ji AT rvO.R .a «. w•« . , <br />e9w«dr T. r.E }drw briW�•t. .N :sd«r,�E. <br />3W <br />�ma. — <br />L . <br />WM THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA <br />STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE ABOVE TO BE <br />A TRUE COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE <br />D$iPARTME%IT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH <br />Is EGAL DEPOSITORY FOR VITAL RECORDS. <br />Issued May 4, 7984 <br />RICHARD H. BECK <br />ASSISTANT DIRECTOR OF HEALTH LINCOLN, NEBRASKA <br />