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86w.. o �g <br />WHEN THIS COPY CARRI994 SED 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 DEPAT -PP HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAI: DEPOSITORY FOR <br />VITAL RECORDS. 111 <br />DATE OF ISSUANCE l' <br />SEP 9 STANLEY S-.: COOP&,� *$ t TOR <br />LINCOLN, NEBRASKA BUREAU 01('VTTA.L ISTICS <br />c< a �` <br />STATE OF NEWASRA— DE►ARTUM OF NEALTN <br />tUREAU Of VITAL STATISTICS <br />CERTIFICATE OF DEATH _ <br />c*cmwr -NAME -FInT MIDDLE LAST sa - - DATE at DfATM [Ay.. Daf. Yr! <br />2 S. <br />tACE- (aR.. Wh:,9, 01.4. A.-k4 O6JG4Pq tSC Y DATE EIEM fMe., <br />Iwd:ww. hlti 1 <br />(Y-) DAYS N G.rw..•.NJ(Sv.�(71 MOB. OURS. WNS. <br />t+ cite S. e.. m e : 7 <br />A TAI aIRM (M wIH iw U.SA.. tI712EN Of WHAT tOUNTR'I MMRIFD. NErlfR MARE,N; I NAALE OF SrOUSt tN w. , a:.9 <br />w.w. wv.rry) I WIDOWED. DIVORCED (SO-or) <br />12 IJs_ 131 <br />CITT, TOWN OR LOCATION OF DEATH INSIDE CITT LIMUS MOSMTAL OE OTMEE M <br />- Iiv.•arY.Iw N.) R"•,r+..I end...wb.r) <br />IQ- 1�. IW. - HD7RE <br />RESIDENCE -STATE t NTT I cfrr. TOWN OE tOCAT10N <br />-. 13w. 1Sb. IIST Grand Isla7, nd <br />Al" -NAM MIDDLE UST AVJTMER- <br />1 17 VI <br />WAS DECtASED IN U -S. ARMED FOKEST 'IN"NWANT- .NAME -aELA TION9 <br />...,. 3�I. ,.._..«......ae...�.......110 -3 (Wife) <br />Ia_ 4 I 42 2 -4— Ir <br />/UMAL-Cnw 6ri a..».w W ICtMETEaY OR cREMATORT -NAME <br />1Ow. 20►. 28 l9Rfi i 2Q. <br />n116.,, I H'MpSI O[ INST IMK.I. UOII <br />Ow.I:..Hfr: Rw,lnrww lfy«J.r <br />�IM. - - - -- <br />INSIDE crrr LIMITS <br />- - 1 - 404A1ME S/GNAIVR 11EEM .y�7� tFUNERAI <br />r �5 J <br />NOME- NAM[ AND ADD— fiT9tfT W 9 r a N6. Cm a Trn+N, 3ia.T, nrr <br />(/ <br />21. 1 22 <br />` QATE / D" 1( ,. 0. - <br />- DATE SIGNED (M.. 0.r. T, 7 'MOUE Oi DEwIM <br />- - y 25.. A 3t 'i4 1986 <br />l +Yi '2Aa. '24b <br />OA _ {AT... D.,, T..) - - (MOUE OF DEATH <br />Ii.' -i _!"ONO.CED DEAD PRONOUNCED DEADIN -4 <br />s 226 Au"s i 28 , 8b12,T. 6. 00—p-- <br />-i��.I � <br />R ' •.wAH JI.I.i <br />.+1 M u M E � Q M ►w.. ✓ - riN. rt <br />_ tt +wif.'iw..:. wr y�•�« d..M swr..d ne <br />(tj[b'/ <br />- <br />_ NAME AMD ADDRESS Of L TSKUN, CORONEYS 911 <br />OR COUNTT ATTORNEY) fT <br />u. o A. WWag�Nerf Jr- 729 Na- Custer <br />Grand Island 2lehracka 68803 <br />- 1lGISTRAR <br />�DATL MEAN By JEGISTW (M... D.,. T,.) <br />:.. (> ...r.,► <br />.Cl. s2,b. SEP 3 1986 <br />27. 1W MAn ((fwfE Ow 1EA t1NE fOrrt ta)s ). •fj� feD �.r...I b.....,...... w �.wx, <br />(�J.,U/SE /OON�LLY <br />WE IQ. OR AS A C ENCE Of- <br />Du I TO. OE AS A CONSEQUENCE OF- <br />w <br />►AQ OT494 fFDJtlFK�Iit CONORMN4 - GMwr,wrrry w IwE M .r .afa>.I ; i:UT IN .Y .fMNt M TMEt! A AYTO­ /� - - j wAS CASE MUM" w Y WAI -" <br />MfG,MNCTWtM!lASt 1MOMTIIfI - fSn..Ar� ` - ltaNWN Ot COAO.IER <br />N <br />,is_'k <br />2.29 <br />AcciowM SUIOR/. MO,HODR. UMRIt, GR p MJYM J14. 0.,. I. ! <br />IMOUa Or IWUa1 N � SCtl wD'.' HUWT OCCUMED <br />ON 00-o IG M•tfTlCAndl li.rd,J 1 <br />20s M 1 <br />R4YIr at 'wORa <br />' i _Ifnvd, rr r M.I <br />i <br />NAC! d MUWT - M I.-. Iww, In.r. Iry IOCATT 1� .__. SIlR W t f D Iv _._•- .-...� cIn Of IDivM Star! _ <br />.Niu MAdn'9• a tfI«drI <br />0 <br />E7 <br />I <br />