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<br />STATE OF NEBRASKA
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEAL TH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, .J,(FtALfn'Ct)R.lJ5,
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. ~,u,~,"". . ~~:, ~:J~~:r~ ~j "
<br />
<br />DATE OF ISSUANCE 20080600r:: -. \[Y. ~,'
<br />it ST.e~LtY :QOeFR " ~ "
<br />JUN 3 0 2008 ASSISTANJ STATE REGISrRA'W
<br />'t:J~.AATMIi!/t1;JF/...HEfL TN AND'
<br />LINCOLN, NEBRASKA -Hlf!4),N9EklitC~$4-....I' :~:.;
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<br />506-16-5893
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<br />- Ne1r8ska Heart R:lspital
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<br />I Lincoln
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<br />Nebraska
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<br />'3 _0f'5POl.I$E 111_ _-_
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<br />.. FAT>*ii. -1lAiIf"" RIST WlDLE
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<br />Willillm Behrens
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<br />OWn H:me
<br />LAST
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<br />17 IKlTIER
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<br />211.,...qI~.i
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<br />___ AOORESS
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<br />William Behrens
<br />ISTAEETORRFONO..ClTYORTQWN STAn Z1PJ
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<br />171SW. John, Grand Island, Nebraska 68803
<br />20 EU8AI.M!A.SlGtoATUIlE&LlCSl8ENO :m IlETIClOClFlllSPO$ITION 2'b OATE
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<br />2'0 CEMETERV(lI;CAE.....'ORV NAME
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<br />Not Blba1med
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<br />10-16-2004 Lincoln Memorial Crea8
<br />21. CEIETERV OR CRIO.....TQRV LOCATiON CIT" OR TOOIIIN STATE
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<br />22a FUNEMI. HOIIl . _
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<br />All, Faiths P\u1eral Bane
<br />
<br />. Lincoln, Nebraska
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<br />l'2I> FUNfRAL HQUE AllORESS
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<br />1S'l"AEET OR RF.D NO CITV OR T~ STAn. ZIPl
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<br />2929 S. lDcust, Grand Island, Nebraska 68801
<br />:!3 _IllATECAuSE IENTERDN\.YQNECAUSE PERLINE~OR.., Ibl ....01011
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<br />OUE TO. OIl ASA~Of---o-""
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<br />~ WoOSCOll8EIiIT~'
<br />D'I'ES 010
<br />
<br />Dr. Giles Hectierich,
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