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<br />STATE OF NEBRASKA <br /> <br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTM~NJ:..... ~Q~ '1€AL;r.#'AND <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF T~r;;, .~ ~~RD ON <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEAL TH AND HUMAN SEUIfli,t!;.F'!!... ~ ~B ,~~ <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS'..:<;~~~'%1!. (:i..~ E; ~~'.'r.,~:,'...'..' 1 .i..A .... <br /> <br />DATE OF ISSUANCE dOC 9 t) D t./-.2 7 .!~ .4Ji~~WcOO;Er::<ljr <br />JAN 1 6 2009 : r:; ~S~Tf,INT:STAIE RqG;!$!kAR <br />, ", i)Elzr.l.frvfEIvMF+fEAL:J:H AND <br />LINCOLN, NEBRASKA .', ~"H.l!f1I;N SERVIC~S ....-""'0. .~: <br />srA'Dgrl~AIDo____or""'MI)JU'ANaw.~'~~:,:'.:" ~ ,',' <br />CER~~'OFwm <)/,,' '1,"9~. <br />j'1OfCED96f.... ,..-r UlDOlE 2 . ..',,~ <br />Lois Ann Februa' '- 13, 2001 <br />. elTVAAClSTAftOFIllIl1" ._..us". __ _ _ <br /> <br />Grand 1 land Nebraska <br />- <br /> <br /> <br />01' CIA'" <br />~~ ~- ~ <br />Ol;ll~ <br />0- <br /> <br />0......- <br />o ....-..c. <br />0-- <br /> <br />507-30-9324 <br />.. 'ACllJT't._ <br /> <br />._-..--~ <br /> <br />BryanLGR Medical Center East <br />I< eft'< 001 LOCATlON '" <br /> <br /> <br />'" <br /> <br />.. _c:rrv_ <br /> <br />---- <br /> <br />Evel <br /> <br />Bockhahn <br /> <br />er <br /> <br />Jlc ~OOICSlEMATOlI'<...._ <br /> <br /> <br />Livin ston-Sondermann F. H. <br />F 0 lID CITY <br /> <br />[]...... 0-- <br />Oc-D- <br /> <br />2-17-01 <br />Ilu ~QACJlIi""'TOIW l <br /> <br />Westlawn MellOrial Park <br />11(JOj CITY 001 Sf... <br /> <br />Grand Island Nebraska <br /> <br />. T"TE~ <br /> <br />I . 601 N. Webb Road. <br /> <br />!~\~~-I\\~ ~kA- <br /> <br />: OUE TO. 011A5" OF <br /> <br />, Il>I C .....'" '^^~ ""'IV <br />~TOQA~~CJ' ~~ <br />~, 'Y>> <br /> <br />. .00000A~~.c...__~_~""'."_1M"_- <br />Po:" ~ State- J.; ~;....~ _ ~ <br /> <br />l'6o .. DATe .. 0.,. "'I a H(UlOF <br /> <br />Grand Island. Nebraska 68803-4050 <br />IfNlVlDNlYONfCAUSlPli'A<lIIE FOl'I'fl.1Ill. MClICll <br /> <br />-~fHl-- <br /> <br />---...- <br /> <br />.- <br /> <br /> <br />o Ace-. 1Jf. ~ <br />Os..c...O.......... <br />0- <br /> <br />... lOCATlON <br /> <br />STOftT OlIVO lID <br /> <br />CITY(lll~ <br /> <br />..... <br /> <br />- DAn_ iIIfo t>>r Or, <br /> <br />-- <br /> <br />i~ ~:. m OAn~ -;;.,' <br />!f~i 'Z...r 01 <br />~ f Iv. ..0; .....__ <br />-- <br /> <br />1881 a_DEAD ....l1li<11'1 _~__ <br />Lg <br /> <br />.. Jil. ...0...._..__.._....___. .. <br />~ a ...__.........._.___ <br /> <br />.. <br /> <br />0- M) <br /> <br />c.-~__ 1\(~___ <br /> <br />304. Lincoln. N.bra.ka 68S10 <br /> <br />1- ~'HFEB20 -milO' <br />