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87=- 104600 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASLG <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO.MrIM <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE <br />BUREAU OF VITAL STATISTICS, WHICH IS THE L <br />VITAL RECORDS. <br />DATE OF ISSUANCE <br />JUL 2 41997 srANL , <br />LINCOLN, NEBRASKA BUREAU d 1FT A <br />STATi OF NEOWNA- 911of"Awl OF NEAITN <br />W09M OF VWX OTATUMS <br />CERT MATE OF DEATH r .: - :: i <br />—11SCIVOR-MAME "EST <br />t"T <br />wAa OatNiae tray M Y.l AYaO IO•[aa7 <br />DATE OF WAIN (w . !,.) <br />Larry <br />Dean McMillen <br />IT Male 12 <br />July 21, 1987 <br />•...:». <br />a s . M.ttr. tr..:... -rr a.�e+.. <br />, r r OAtt or fw.. D.r. ►..) <br />,.e«. «iitar«+ba <br />r White <br />w.►ra•«arj rrn) <br />$ American 51 <br />oAn rwa <br />,3u1 21, 1936 <br />CITT AM STATE Of SMITH TV +w ,. V J . WMA <br />_12LLivingston- <br />MAW f wMM, rrwe) <br />Maabe . Minnesota <br />�� U.S.A <br />w,,w40. 0r-vK w (anx) <br />w Married <br />A nes Twe. isiw to <br />"UNDER Wvum <br />cWAtiOMf &ew MIMeM MMIMw�iwM RMrO01 LYaMNSt Of,M9Yavin <br />cOYMrrWOIAM <br />-38 -5706 ,u erinteadant ,a School <br />, Hall <br />&.047'5 <br />a ktXAROM O► oSA. <br />—M w%d . <br />INSIDE Gm swttS <br />"OEM I"on OtINS WSIRY r MOM w Ma, ,.rr.w •Or. <br />otir -A— I.. w«tS -4 <br />IM Doniphan <br />w) <br />s».. <br />, At w 310 N. 4th ,.. NA <br />tuMeaNCa —antt <br />Comm" <br />cm.rOvrr.wuxAMOM av„grAtWrru.e•ate <br />,Ma�o�cmuvula <br />Nebraska <br />vat► <br />Hall <br />,sk. Doni han w. 310 N. 4th <br />Leland NMN <br />McMillen 1, Agnes NMN Tollefson <br />wAa OatNiae tray M Y.l AYaO IO•[aa7 <br />woomm"" -" AM - aatAIPONS00 - HNUSO ADMU Arwt w s., •. MO. CM 08,0wK suit am <br />n........0 tr r.. r• r w ee.w r w.ne, <br />f <br />t•A ens McMillen Wife 310 N. 4th. Doniphaant Ne. 68832 <br />WMAt <br />cwltlaarOMCNtAaaOtn =MAW cmO.lowM s1Rri <br />CATION <br />Cretion aw Jui 22,1987 mCentral Nab. Cremation Sery Gibbon, Nebraska _ <br />ma II <br />- <br />-MAW A04 AMOMS ~Gott* Mot C M w towel vM1v' iM, 68801 <br />Not Embalmed <br />�Sondermsnn 505 West Koeni Grand Island, Ne. <br />"4* 0".. rrs <br />M (q-. M <br />_12LLivingston- <br />W 01AF" <br />aw aw r <br />i ~. <br />y <br />—,v&, - O <br />1� r � <br />aft Ii a <br />—M w%d . <br />El <br />e <br />'.I <br />J <br />