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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A.TRUR COPY.
<br />OF AN ORLGINAL RECORD ON FILE WITH THE STATE DEPARTMENT- OF -AAi u
<br />-.
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOOiTORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE �"_ "`/
<br />- AUG 2 1 1W, STANLEY S. COOPSR,_DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITA+ g'TATISTft5 -°l
<br />sTAU of Nt "1"- wMnwff or NMTN 86-- 105478
<br />NUADU of ma STAnsncs
<br />CERTIFICATE OF DEATH
<br />,. DECEDENT -NAME Fiat MI _ - _ " �OA n Of DEAM LAM: De-, Ts!
<br />r I Richard Leslie Uhrich Male J, August 12, 1986
<br />- FACE -1. �., Ur1,iI. fNd, Arrive 01OMtD[SCENTp f., A.ii.w,Mpi,r. AGE -r Rte...,
<br />VNDEf I TEA! - YNO@ l Ol1T DAif OF fIRTNtAM_D.T.. ►rt -
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<br />AKM. DAIS t i10VRS � WNS. -
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<br />C • ATE OF f"M(NM f. V.S.f_.
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<br />CInEEN OF MNATCOUNro .NEVER MAMM
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<br />NAME OF SPOUSE IIF- E,_p.er "- w..y ..
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<br />+roo..ED.D,voRCEgrs,..:,Tt l
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<br />R. Hastin s, Nebraska
<br />v. USA If) Married
<br />{,,Glad s Deveraux
<br />SOCw mcuorw NUMfN uSUKOCCUrATION(G:..,i . d.t wrfdwd.«.v...a jRH+Dar WANEif OR(NdISTR. CMM"OFMATH _
<br />„5Oo -O5 -5343 ,a. germinal Manager n►Truckin Co. s.. HaI2
<br />Cm.TO.., C , OF DEATH
<br />INSME Cm Lpm MOSrRAEp OTMER INSTIMION -Her ((sw,r +w w,M. •.atr a.,fT,A.w fD..
<br />I.b.Grand Island
<br />T.. 2003 North Sherman ,..
<br />RESIDENCE -STATE [OUMTT
<br />Cm,TOwN OfIOCATgN STREET AND NUWER
<br />-
<br />,s..Nebraska /T►. Hall
<br />1s�. Grand Island ?sa 2003" North Sherman 'rs. Yes
<br />A MIDOIE jMO7MH- MAIOE,f NAME f1R57 .' _ -ME LAW
<br />_ _-
<br />16 George G. Uhrich in. Anna M. C,aqm�erzel-I
<br />t$ OKEASED WN IN U.S. ARMED FORCES? I INIOMYNT -- NAME -&RAI .SNIl -MMUNG ADDRESS 11TREEi D... D +.o. C-a
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<br />6atS�u_f� NO — tvMrs. Glad s Uhrich Wife 2003 N. Sherman Grand Island NE,
<br />CEMETEfT OR CREMATORY -NAME - LOCATION- - CRT OR TOWN '. .STATE
<br />-
<br />Burial 1986 wk'arkview Cemetery ,Dd. Hastin s Nebraska
<br />-- -S1GNA iVC [ G R/NERAt MOMS -NiME A"ADWSS (STwMlF D- NV.0 -Of 10.K SuTL Ma
<br />Hastings, Nebraska 68901
<br />j,zLivia stop- Butler - Volland Funeral -Home 1225 N_ E3=,
<br />DAN DEATH tM.., a". r i DATE rw.De -, r.J .0m of REAM
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<br />nA Au ust 12 1446
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<br />- •. -NAME - - OR COUNTY ATtORNf" fl,.. « P. )
<br />C. Dean.McGrath, M.D., P.O. Box 2339, Grand Island. NE 68842
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