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i TO er #_ _ <br />D. 010= S{GiRS#CA= CONDITIONS <br />. C.dMfr.Arf rr ri A� iai a.r _. 'iI3T <br />i.a OAZ- Of Olaw -e #!.. MAJOR i7T4U04G3 OF OrtRJ1YiDEt <br />- <br />1.- - - TsC N. _ <br />}: 2ta. Al7QDLTir AS..rY*)L ' '31 PLACE OF O4,1LKT tr is w rir t± L3s.. i"ii'r a& Te"k - _ #COC.WY) isrATiy <br />li _- SMUDI �ler. larw.. CrtMrY a--%. atv— bu— ac_): oil r-a waa.. �aiM OiFNAL! _ <br />- NOVIUVIL - - - <br />f 2#L arc AuL hf #%Vj itar9 fn .rte 2 w►.7..s iiVarA -FG NOW D10 Moray 00'R` _ - or <br />122.1 hereby cestiry that i atteoded the deee..ed 1ro - ..1�- .3a.__. ts_f,?y ta__ -f£? � 1#j -y 2l.Q_.. Mal taw a.: the de - - <br />fi ce..cd aai.e o..1Q�L ? -. x153_.. wuf That de.t1► eccrred atw�n:.. Iraq. t#e oer.ca and on the date uasa dart. - <br />.' aa�,9G.lA flRnw : rJO.) 1 DOerea '-21c WaT=- MCZMD - <br />aL'IIiwL 2.\ DATt ; 2.r. NAME Or CZUXT Y OR CBi][ATMT Zia utCaTION iCft_Mrarr :a..ay -) <br />t'AlYATION J - - <br />rtttfOPAL i14 i — �a}..'iQ c�” 4 - iz.. A 0.1 % iie 1aarl #ems` —ate atl �ja ti, REMS +ens <br />DATA ■iot3t •T LOCAL a lt'! 3IGNA 2s, i'OZIfBAL DI1tEt,?OiS7 SN:1twSVg# ane.. _ F <br />- vuW <br />WTiFN THIS COPT CARRIES THE RAISED SF,,tL OF TiE NEBRASKA S7ATE <br />DEPARTMENT OF HEALTH, 17 CERTIFIES :'E BF-0w '-.0 SR A 14VE.COPX <br />OF AN ORIGINAL RECORD € N FILE WIT i?i ST OEPARTIS�v'T OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH I(S� ?RF LEGAL L+ d5i7t1RY FOR"' <br />- <br />r V <br />VITAL RECORDS. 87— 100950 - <br />DATE OF ISSUANCE <br />FEB 1 7 1987 S :, ;LEF 5..,�PER, DIRECT <br />;NCOUN, NEBRASKA 3___ _ F +* OF L.:1AI:': STATISTICS <br />&. rllS - <br />ij <br />- <br />iw►� M MrY s1 J 3 �� <br />. I <br />sUZtNO. 126 — <br />—__. C <br />- L -r#JCR Or MATE - JJEOAL <br />oyLwrr } r <br />r ? ✓ <br />a. e:TT in o mm. wrSw.1. 0.1.. w1M aw }3 e. L [ N C T M Or a Cm #M wAni* � 1�N.. � ft JWMA14 - <br />TO anu ; and srAT ,.p1�r,r Grand Island <br />i 7 <br />-'M i <br />- <br />1 L % 17bn) L S t # ) t DATE _ ON-ft # # <br />w t►brt Vincen& Andrews DRAATR Oct. 18. <br />.. L as a cows .. sACe, . iuttsim. sttTd aARNOW I a DATE Or OWN a wua.' I <br />;. Val E white a W <br />- 30� USUAL OCCVtATMIi) ICha W.t +R r.wij).► NJl#D Qr iL Amm- Kkv, rrra s ....t►) <br />+tls 06...w Y wfl.y OR DrDUM1101 = - ri3Q w #.ate.. writs} o <br />oamtr ; <br />*: ' Cedar , ids xebr..1 U. Qsj A <br />-. M rATT#Q'! NAM - _ j #t.. YIOT =LE7 142DOt lUIR � � xAMR or A#!_!r_.irt#O ill: is.Si <br />Arthur A 1 Nara* root I Clara Roainscn tlsta'retts <br />' M VAN DUMA a t . A, D QM7 ! i MC, aLvu= <br />(Ta . BQOr lUi w a A/i. ' <br />' <br />No _ Kra. Clara Andress <br />-414& CAUSE Or DRATW <br />Ui "�lix LIU.�To D"Mr <br />s <br />ta)_ iSF, ....�..` • �., t <br />_ <br />A.NTtCS MT 1r_%U3L7 t <br />t - <br />a1r. <br />EMU <br />