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F <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STAg"oI <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE Cop <br />OF AN ORIGINAL RECORD ON FILE WITH"'THE STATE DEPARTMENT-0- Y� <br />BUREAU OF VITAL DEPOSI STATISTICS, WHICH IS THE LEGAL R-kikALT <br />VITAL RECORDS. tuy. Fok <br />DATE OF ISSUANCE <br />MAR 2 6 1985 STANLEY S.'CO6 <br />LINCOLN, NEBRASKA <br />BUREAU OF VITAL' <br />----------- <br />STATE OF NEBRASKA — DEPARTMErWir oF HEALTH <br />Bureau of Vital Statistic. <br />CERTIFICATE OF DEATH <br />I six <br />73. 02132 <br />DATE Of DEATH P -0#4101, Dow, <br />z AFA 3 <br />-71-11 . —. I I , - 2t,. 1! --u---- -)42 <br />41,411" ­­ . I - -T I DATE (>F §I1jj?jH <br />to 'A() S VIAII !zo NTyF(f)Df,%1m <br />white 79 <br />-I- T - <br />'J &ATION j:j -6FA Jan <br />-q- <br />SO4TAt OR OT"fa <br />19 Grand Is.Land lwSflytifldw- NAm des ISNOF —mr-I - ..;FciiIZEN 6i li-­ -Park side -Nursinf!, Hom <br />I MMQ* D. NEVER MAJIMEJ). <br />1 WOOV40, DIVOKED i <br />U ozi. A. widowed <br />.!:�Al 11 CUPAITION .,.o 0, Wool C.U"I oull"c­ _none <br />4,03111 0. <br />OF BUSINESS OR INDUSTRY <br />14"TA, <br />–!�ng .;j*-­--?­r-ac-ticp1 hurse NS r <br />'OWN Oil 16ZA 16t� <br />C -4�me <br />Ffti�j — S FA rf OU <br />rSj <br />I REP All <br />Nebp W d River <br />- MAW 1,14F <br />IS Han <br />I unk <br />MAW - RIFIATION30fir j AILA It ING, ADDRESS f1heresa —kunk) Buhrman <br />%tot <br />It Mrs r dawqhte�,7b I of a I b -t) <br />DIAYN WAS CAUSED Ep IX Shel;on, Nebraska t)8,976 <br />I F Nlf RPM Y OPO A 1,1y( pfm frij (.)R f, t), AND A <br />A'• ­ 'Al <br />fit- r <br />C-14 GI"Pd CC)NT`E`&`JlIP4G TO DEATH OW 0401 &ItATtEl 1A.1 .1 1, WAS T A AUTOeSf tF Y 5 <br />to of"IFE W I <br />I MONTHS? 1, -14, '"W.Gs c(t. <br />ts "a 916,42fa I. I-I"Q <br />YES i No 00 01.1 <br />ion ~m*AW40, 'I.@, P40UR - ­ I" ' , ' , --1 <br />JW INJURY (x(.URIffj) <br />Ip <br />to "FU 24 0# I""op 00 'Aff IJM IS <br />m"T AT jftACf of <br />I <br />114". FIE <br />!10 <br />AT"— -.LItItT. "V <br />oI <br />To <br />At III <br />JW <br />As It CIO chublso $'Alto <br />04 4", 011 <br />meaft (X�.0m ON low D.,11 <br />J•I? <br />_J/ <br />of <br />­a- <br />Bt, ri NAM( <br />Ot Ma ry <br />WIDOd id ve Nebra sk a <br />r <br />Feb' NAME AND A <br />ME ftne ver <br />SIGNA IUSJ #40 ­— ---- hl"" <br />j, 111�11't. WOOd rakka t3t�bbj <br />11 iic�rc <br />I'M 1;01 <br />L­ <br />--i <br />