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STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARIM~T ~pF~A~TH ANP
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF ~FI~,~R'IG`XNA~r,L~C~RD QN
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN S~•121~C ~f~,~: R~I~IZD$
<br />OFFICE, WHICM IS THE LEGAL DEPOSITORY FOR VITAL RECORDS '~ ~ •'~` '
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<br />DATE QF ISSUANCE - ~ ,,,~ r t , ;
<br />JUL ~ ~ ZOU,~ sT ~a~ QOPER: ~ ,.
<br />2 0 0 9 o s~ i s `A'~AS~7`A'lv~' S'T`ATE REGI9'TRAR
<br />;.A,tJEPARTME',(V7' OF M~ALTH, :AND
<br />LINCOLN, NEBRASKA ' `.;{-lUI~i,1fi~,.~ERV14'ES ~ ~;-
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<br />CER7'[F[CATE OF DEATH
<br />T NT .1M7E FN16T MIDDIe LAST sEx a wTE of OfAT1l e'1w.15ui1
<br />Edgard Henr~* 4~anousek Bale Decker S, 2002
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<br />Fleaaanton, Neebraska I
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<br />December 17, i9i4
<br />7 ,lD4all9[GilliTn' M .E OF DEAiN
<br />507-1b-2897 "-vsF'T
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<br />St. Francis Magical Center
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<br />Grand Island
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<br />M SM)~ • STATE 1 fE (:OUH7Y Cjry, TDWN OR 4OCATM)t. Af. STREET AND NUMrER IRIdINYg2ly Caatl 9a ,N~7f kM111[f
<br />j Nebraska Hall Shelton 18234 W. 13th 68876 i Y« ~ w (]
<br />t0 • N 11. YMy1e. BIACM AmrCMt NtliAn. 11. ANCESTRi H•q. IriY,. Mw.r~1,. Cimwn p[, ,2. rj YANgED ^ NNDOM,E4 ,0. NAME Qi MOUSE
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<br />CxeCh NEVEF DIVORCED Vera Dubba
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<br />M FATFEFi-NAVE FriST MIDGI.E
<br />~.LA57 ._~....~MplMEii - _ FIRST UrOGIE MA(1E/. SUM/AfAE
<br />Frank Iianousek + Anna ~linkacek
<br />+r wAS oECEASeD EYkR xa v.s. ARMED FOgCES?
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<br />" ,na rUFORMAk7 • NAME "'~""""'
<br />~to Vera Hanousek
<br />176 WFOfrAANT MA7JN ADDRESS ISi~q. F1D. CITY OR TpWN. STATE 21W
<br />1$234 West 13th, Shelton, NE. 6887b
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<br />NC'! 2'a. METIh7p OF DKPOS,TgN 216. DATE ~ • 21t CEMETERY OR Gir:MATfw,'~ NAaE ~. ~.
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<br /> ~Z2 ®~,,,., ~R,/„ar.,! Dec, 9, 2442 Ga~feron Cesetery
<br />~' ` . N ~ 21tl CEMETERY qp CpEMAT717Y LOCA7M)M ~ ~ /i ~ pia TpM`~- STAT(
<br />l ApfeZ• Funeral Home ^~^ ^D~^~ j Gairo, NE.
<br />17~. FIMERAL 11ppE ADDRESS (STREET f.IR RF.b. ND. pTY pR TdNN . STATE. 2H+1 •~ ~""
<br />~~,11 West 11th, Wood River, NE 68883
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<br />31 NAME ANp Ai.'JREbF:JF C4n~IF!fp ~F/`IS,(;IAN,G7kiNE95 ^MTSxi~Ah pFI CCX:NT
<br />Kimberly A~ Nickels ~7~
<br />:R. FEWSTRM -""
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<br />. Custer, Grand Island, NE. 68803
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