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87- 104731 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TUBS A TRUE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE.DEP T: OF ;HEALTH <br />BUREAU OF VITAL STATISTICS. WHICH IS THE L - ,'1EM1116kT FOR <br />YITAL RECORDS. <br />DATE OF ISSUANCE 1 41 <br />JUL 2 4 Sfi s COGM" , 61RECTOR <br />LINCOLN, NEBRASKA BUREAU ,.rPTAt ,STATISTICS <br />STATE OF NEBRASQA- ®EiARTMENT W NEALTN <br />WJKW W VITAL STATISTICS <br />CERTIFICATE Of DEATH <br />010641411-9401 vw Mimi LAST CIA A (AM. ►.Tj <br />Larry Dean McMillen Male July 21, 1987 <br />It.7.. wl.., k AMrip. EwMt t , 1 DAR CAT! OT eHTN (AM.. Dy. Y,.) <br />AM)S. DAVE NOUtt• MINE. i <br />White American 51 ,, i'July 21, 1936 <br />STATE / .M:. US A. t ,TI! « W"A COU NAME t!(K�. t'�...:Mw..*.1 <br />...w..s.•I,N rN WIOOwto. avotcto(s...:rr) 1 <br />Mabel, Minnesota F , U.S.A 1t, Married I„ A nes TWeito <br />SOCIAL wCus" INIrNR UtUM <br />.!M �OC <br />I.(. eroT Mw. �.,iry n.et tMID . Oi awswf Ot INPUSTITT COUN" OMAT" <br />17 570 School Hall <br />CITY. OtLOCATION OF "At" INSro! CITY IMMn MOSYItAT W OT"tt M.STIw1MJN -«.r rM..... ...A... n w06. a 041 ......e. DOA. <br />filK' Yu A. rAl Nw Mw.I..i rwM,) O.Ww.W.+. v - Nw.. 17H.M <br />Doni han 1.r 'des , At Hottte- 310 N. 4th ,.. NA <br />ttfWt«C! -ETATt <br />COUNTY N OR LOCATION sME AMO «Urtlt "a" CITY tMYn <br />PEVN,�T M «tNl <br />IE.. Nebraska ,� Hall u, Doni han I� 310 N. 4th 1E0 Tes <br />LAST AVOTH911 - JAAIMN HAW VIIMT <br />Leland NMN McMillen Agnes NMN Tollefson <br />WAS OMAEto am IN U ATMND,OK"? MMIOtM A«t- NAME - ttIAt10N5*N --MAP 40 ADMU IErMTI d... Mo. CIII M LOLL.. HAW SNI -� <br />ITa .. • .w 1M t«........ w .w..e w..,..1 <br />ce, lfo - -- - - -- Is.A ens McMillen KWife2_310 N. -4th, Doniphan, Ne. 68832 <br />b...e t � ClANtlN Ot CtlrAATOtY - NAMI <br />LOCATION COY 09 TOW« ETAt! <br />Eo. Cremation . Jul 22.1987 ]6cC@nCral Neb. Cremation Sery Gibbon, Nebraska _ <br />low wo r - M;-w AID •�tlfr °- ism" as t I 0 "o . on a row*. WAIT. tw, 68801 <br />Not Embalmed _ip2Livingston-Sondermann 505 West Koenig, Grand Island, Ne. <br />man Of EPEANN "%,. N. r,.1 !� I (M. r- J A <br />DI <br />MR �11� - -- i fM'Kt$I�M_ ..! ®DtADAMwa/ <br />VIP <br />7 L, j <br />J � <br />.Y I•*AMw �*.M r W A w * r <br />_ 0. +. Mtw M .w.M.M. wA. •+epMw• w q .t:..« bM wsr..s .. <br />-- -COUNIV A Yl • a y �% <br />Dr. S.F. Nabity. M.D. 2444 West Faidly Street Grand Island. Nebr. <br />o r ► .uAW&c•y " lam. J� 4 RRT <br />r'et INK r.r. 6.1. AM PU) I.+....t.....r ...w ... Aww <br />fm <br />CAW 1 - .. .... r 4-4 ►a.e...%AW NN Y N ".M% WAIL to vAuthk <br />b TNN! • AUIDiY MuE CAN <br />I ,M.IrrICI N rA5:7 t (T�..i1, Iw r / ftA.WNt p C <br />/.ice S►.rirl t* M <br />Mtta.Wltl rre... ..I. FJ MOWO MOW MUWw OCCW� <br />t.MItIO sltrlOA/eON. n...4/ <br />a. M , <br />._ r W.W. Ne+, MY.1. LoCATNIN wor m tr.0. 9% CITY W tow" I" <br />M" .Mew ISO 00 <br />!t EM. <br />