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87---- 104900 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE_L9G6L °DEPO$i•TORY FOR <br />VITAL RECORDS... ' A <br />DATE OF ISSUANCE <br />JUL a 6 STAI4VY. S. COOPERS DIRECTOR <br />LINCOLN, NEBRASKA BUREAd! V TAD;STATISTICS <br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS <br />CERTIFICATE OF DEATH -(, <br />N _NAME !I u - -- I S l --- -to.rE a DEA H �M. I. i <br />tACt- I.f:.wb.A.WINR.Awro,w.w OtTGINfDESCWTI. D- Iroi.m. Me.Hen, AGE -I.N R..u.. UNDERI LEA! UNPlfID OAT! FfInv.(M. O.r.r.I <br />- L - T._ <br />Iwi.•w. )(S•a. G...•w•Na )I5 ITl• It..l � MQS DABS' NOU[S. MINS, <br />a �O7C 16. :r—!m -- -_- r�L oZ <br />1 • STATE OWN Ill .a+. U.S A. CITIZEN CN WHAT COUNTRY MAR[IED. NEVER MARRIED, tNAMl OE SPM I(If �. /. •..e w.e. .20 <br />.. ,,,,•i wIDOwED. DIVOfC <br />t. • _ ID �lTQ�6�,l�f���� <br />30CI NUALDto USUAL OCCU•ATIOE/(G...1. del e.Y dewe dr. ny .w'r KIND ' O /fU5tNE55 OR INOUSTft ,COUNTT OF DEATH <br />�•y d...R.wfl.h. r.w d. .•ail,.,.,. �E�� i i <br />1Z �S�v/ �� .I":W� & `x•;;I •y'1ti _ iI. -y l(� i1e. lt•- iVLL'1[2 ._ —_ <br />CITY. TOWN Of LOCATION Of DEATH INSIDE CITY LIMITS NOjNTAL Of OTHER INSTITUTION - N.- (I/..1 Yn ••rM.. ' p— NOS. O�E� / l.e•. s.. DOA <br />e•' �'t.�' "s"�.Saw err <br />' <br />I4 1 ed� /.J /I-1•�VfGe�� �1S15R I I s.1N��[.E...x <br />[ESIOlNCE -SIAI! �COU"TV , CITT. TOWN OR tOCATION -- TSTtEET AND NUMDE! INSIDE CIT LIMITS <br />U ' / �/t <br />IS.NEe�easER I„ /IAe•.Lw IISr �PAluo.LAND <br />r AT141111 - MhIi LASS. -40TNEE - MAMEN HAMI— IRSE•- MI DDit .Al! <br />- -j <br />DECEASED EVER IN U S AIMED FOKES <br />INEOEMANT - NAME - MATIONSHtI' MA ING ADDtfSS S+Eett OR R 1 D NO C." OR tow $,.It 9.11 <br />( — <br />h <br />� <br />1• UAOMi rLl�W. 73. � Nl�at <br />AA. I•- �AT� <br />Ge�ti�u 1 /'f! <br />iC!M[TEIT Of CtEMATOR - NAME i IOCAEION Carr OR TOwN ATE <br />! c oL�u�/V <br />�]'uy► /917 <br />ra+�_i�v�Lri1�C /.c�ggsk,4 <br />1MEf- NA V lK NSE <br />NFU Ef•l N IAN •D of TR D NO cl OR +OwN Suit fin <br />DT. .. <br />_ s?...zr" Liucoldt- Alfa ES6SY3. <br />DAIS Of NATO (MR.. 0". Y,.f <br />; OW $16-10 IM. ,... , H Uf OF DEATH <br />I;2�DATF <br />DDa <br />w STN 'lib M <br />{�D <br />5101,11D (Mo.. D.P. r, <br />'f 'D , T,j Lao rfa.ovi+cioouorH . e,l <br />/{7�� • <br />j <br />I. Nr 6. 1 <br />M lee 7Ad M <br />- dw — ...1 e.• 4 .N — ; E o- M b—. <br />uw. N....e e1....M M. w •.....Nel .....e <br />I <br />,1 MyMW. eN T.p.I B► <br />n.w <br />1 IF" SKIM <br />IYNTS IAN OI COUN ATTO[NETitrr•e e. I..NE <br />.L <br />//�� <br />W AW& Ato. <br />At 4242 larnm Omba,Nr — <br />• <br />DATE ftCEEVfD DT REGIStuitM. D.r, t. l <br />JUL 141987 <br />D....t 3►�' <br />i .�% ERb <br />• AUN ( NS t CIAK;rAfll <br />•E■ LINE FOR 1.,. (b). AND IHI I.ynN b....« «..+.N dwp. <br />Iwa +V. w 1e • <Ywa[VVC.Ri <br />I at <br />bw to. of As • caaseartNc a.. <br />r If .....« b..w« «..+ w a..lb <br />Id <br />$ PAW Yi i. a.NbwD W a...A ....r .N..N j E tfN N rtNAll Ai TMlR! A AYtOyT <br />►NGNANCY u.:H! BAST I MONTNST IIee.Ylr T.. .. NN <br />AS CAN RRIIHRp 10 WDKA1 <br />IRAWN; <br />. .. .. _ <br />� <br />«Df �ORONEf <br />D.HIfE II.►. Dq. t. .l <br />NOW d IMURT <br />WIC "! HOW NNuRt oCCYRRED <br />� 6D EtElflDtD RIRf{fit.ATIDN /:A.IdFI - <br />. <br />M <br />i0/ <br />/.n... •...r. Ie ee1.. <br />IDCATPON INSET q R. D w CIF q TOWN ETATI <br />f••rlreM R.. v NN <br />e11.N R••I�'•► RRk H✓N <br />u <br />J <br />