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- WHEN THl3 CQPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH A':FIUMAN SER) /ICES SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE OR/G1NAt ItE~Rt?~a~ FILE WITH THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS.~~~~~_TI~DiN,~![_lilCH IS THE LEGALOEPOSlTORYFORVITALRECORDS. - - ---~- ~` DATE OF ISSUANCE r~ANL~I!.5. CQ~PER MAY ~ 1 2005 dsslsra~lTS~a~~rEGis-rxaR LINCOLN, NEBRASKA 2 0 0 9 0'7 G S 2 HEALTH anti HlIyNAN ~ERVI SYS1.~M. ~T,AT6QF1~18f~RA~IG4D6PK1'!'I~ir0~N1iAL7HAliDWilA118~tV1471~!'YU~' _-- . VQYILSlRIlSI1CS = CERTIFICATE OF DEATH --- - ~. -- NAIiE r uloD1.E LAST 2. SEx a DA TH Arr. TYwI _ John Ja®e~s Bur and male Diu ust ~4, 2!~pi a p1Y AND 8TA1E M'+1a11+U. A.. A,r1/a11Abr1 5t A(iE • lrM BIIMT UNOLR I YEM l)i18[7 Sb NIOS I DAYS sc HOLM1i .Aberdeen Souh Dakota rv~.l ~9 ~. NUMBER 503'-24-2055 ~ FA~,B,ITY-Milb, prof rlAliipt qMl NrefAbd/MnbMl 'St Francis medical Center -EC.CITF: T(11rNaR LOGATgN DEATN -.. _Grand Island M, RES10~1CE-STATE Bb. COUNTY ~. s^ PLACE aF DEATH Fk~P1TAL: ~] rl,.rr~ EN OIIpMiillt ^ DW wIS;De usY Lmxrs !~ cafxlTY of DEr r,r ~ Htl ^ Ha i i_-- 10. 7yl~E' 1.+&• IAllliM. ~ AnrICr6Y:IrFrll. ~ 71. AN~ESTRr IRE.. 1Y1f1/L 1Apnc,n O/MArM1 MCI M~11 White fl German ,.. LLBUUOaxIPAT1aN rc++dl,T~r.atrbn.rlr+lDrlas +~e FnwaFeuaBlESs grnalB~.ww,+b~+~ Journ~-man Castfftter as Com /f; FA7YIp1-NAIME ~T NMPOLE tAST _ soe Hurgard+ ii WAS Ofi EVER tlu U.8. Alr>AfED FORCEBT lia b~ V 6. D' F aRTH }Y,y ~ Aril 20r 1932 oT~ ^ Nypnn HMIb a ^ AIM /L~ IIIIf~ED ^ YYbOMIL'D 18 NAVE NEVER DAraR~ED n e 15. EbIIC:ATIpN iS Eylredlljrd EM parr j ~~ aloa Eva "M`"~°~`' " ~~'~4 1 An ela eur ar ~~~ /8b.-NFG11iMMT IAALBIG ADDRESS (STREET OR RF.P. NO.. CRY DR TOAM STATE, DPI 102E 18th Grand Island, NE 68801 -io EiipALT~FA•SKiNATLM1EaLICENBENL) 21e uErnooGFU~aos+ror+ 21b. DATE _ Not embalmed ^ Bur1Y ^ aie~lwr Aug 5 ?d FIMIFTW.HLIIYE-NA4E 21tl CE4ETER1 tcieine Funerai Home ~~"""°" ^°°""°" gib. FUNEIIAL, HDYE ACI7f+ES8 (STREET 4R RP.0. NO. CITY OR TOBM. STATE D% 3213 W Norlth F{r~o~nt St Grand Ieiand, NE _~_-_~ urBraEeM]~GAUBE~ ~ +}~{ (t,Q~C' (ENTER ONLr ONE CAUSE PER L,IE FGR ~u la, rvaD K PApT /~• A$ A CONySE~O-UE-NC~E O!F ~ ~~*~_ ~ ~bMI11M11MgM /WM~ KY SKiWFICAirt . Ca+Armlb caMd1An01o,y tle+l bell nM rMwtl PART 111 IF FEAAµE WAS TNEEp£ A 34 AUTOP$' TS ~ MMS C.AIIE REFitB111E0 TOE PART ' - + b PREfiNMICY AI THE PAST 7 gAOIYTNS~ ETtA~/+El1 ~O911G~11lT' (('' V ` ~ :4541 Y,a ND Ylrt~ No Yrr IM pg, ._.. _ lib. OAT'E IIiAlRY Ab. 0'ar. 171 25c NOUR OF l~.A1Rr 26tl DESCRME Hp1Al bLltYri OCCURRED ~ SVaTgI ~ ~q ~9 LOCATION ~ STREET Oii RF D ND ~ Y ~ 1A 110~!~. Ynn. 7n.11 y1~FY P[6 ^41URY AT HtOFBL 2b P~.M1A S dTb OR TOMIN /MTE ^ gbinCedr inMM~FbII 4 Oic+p YM{ ^ Np ^ I I ?TaA DATE OF DEATH AIW. Dp. ril ?BA DATE SK9Nfe..i lAb. Gvr Yr! ~ YtMr OF pEA7H B ~3' 2Yh GATE µb.Orr Yrl T74 TNAE OF DEATH '~ 21fC PRONDUNCED OEAp Mb. urr rrl Bld. PRD110UNCED DEAD P4r+n ~y ~t~ M B 7Ytl. TO mod, / pCIV~WY .dw iM111,G0 AlIC du.~to lty a~ ~r On N16 bMAMbtanw~~Yd TX +IVWY~~IrT ~~tlYln aCalwre^ gRAMIN v ~ rlrhnlr.tlM, And bglC, rnd dlle tlrM CW9ulM firti Ir~~T bM TN! 2Y. DiD TOBACCO IiSE COCTfAIBUTE TO 9DA NAS ORGAN OR TISSUE DONATION BEEN OONSgERED+ 30.b WAS GO/I~iEN'1 ORANTF.V~ ^ rES ~ NO uNM-qNM ~ YES ~ NO ^ YES ~ ND 91 M.111AE AND ADDRESS OF CERIIFTER fPHrSCVW. COpONER S PItYSYCSYi OR COUNTY ATTORNEY( ; YIp, p Pnn, Ryan D. Gsa~Ch IrD, 800 N. A1. treet Island N8 68843 32b PATE FILED BY REGISTRAR A110.. Orr n1 ~~ AE~,AAR ~ AUG ?2001 Yw I.7f w p.1D f~f~F 11ap5~1 vo1Tc O1 1Central ~ie~~~~an'-'~` iIATORY LOCATION GTr OR TOYNi STATE