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~ ~ <br />rrs~~ ~ ~ ~ ~ ,-~ G <br />~r~ ~ <br /> <br />~ ~ ~ ~ ~ ~ ~ j,, <br />r ccf O -1 ~ ~ <br /> <br /> <br />~~ ~ opt ~ ~ ~ ~,R ~. ~ <br />~ rn ~ rn ~ '~ Ta~ C~~ ~ ~ <br /> r <br /> ~~ ~ ~ <br /> <br />~..~ <br />N <br />,•,,~ <br />u ~ <br />cn l <br />~ <br />Irr~ Qa ~ N ~ <br />~. ~. <br /> •~ . <br />STATE OF NEBRASKA <br />.~ .. <br />,~ . <br />WHEN TMIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTME~fi' Q~ H~~IL,~TH:4NQ <br />HUMAN SERVICES, lT CERTIFIES THE BELOW TO BE A TRUE COPY OF THF~RIC~:~IVAL •REL{OfiD,ON, <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVIC.E~;.~VIfi.4L~'G1RD5 ' <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. .. - <br />,,1•, <br />DATE OF ISSUANCE <br />(~ (~ ~~ss STAI~LEY~, ,, • ~ ,; <br />SEP `~ ~ ?00~ ~ II O a7 O 8 ~ V ~ AS.~IS;TACUT S~'~T~ REGfiSTk~,4R~' <br />DEPAR•TNJa~NT L)~!',HE,~~'7'~1 ~I~ND~" <br />LINCOLN, NEBRASKA HUMAI~I S~2~C3'`~• ,~ ~•• <br />i'1ASQli~RAfILMDRtAR7~ilONIRAi.1lIAI'~I~~IAI~#tVIC~4PpiAliCiAt~ilflll0RT ~~';.''1 ';. .w.," <br />YRA45'~A'/N~ <br />c~rn~re c~ n~,7x ~ ~ Q ~1~~~ <br />__-.. _____.... ._._.__. IIDtlT-AL~ ^ NpWa+ DTHER: ~ NpWy~ <br />In sACARY-,r.. Ar wrwrw ^ SR 01IWIM1t ^ RN4nn <br />m. - ....a ..~..~ ..~..«.... ^ Dow. ^ nw« r <br />we ~uunwswu~nxrwmw.suw: V ~ .~vreww..~o.wa+nw~ <br />~ ~- - <br />DuEro.oRASAoun,~DF: ~,. '-' M,.~wu:Yrww~ar...re.,w" <br />•A(~T CpUgA~p IoM dM/~ W ~ql rMrd PART M F FEMME WA9 iIERE A 2M AUTGPBY 75. WAS CASE TO <br />M <br />PREGNANCY N1 THE PAST ] MDNTNS~ <br />AMNIER 011 CORDNEM <br /> <br />' IAYp ~0•St) T~{ NC Yq Pb Y~ Ib <br />7!~ flb. DAVE OF MiAlRY MAa. DrK YW 4le. IIDIIR OF fUIIRY 4!n DEBCRAIE HOW iN:uRY OCCUANED <br /> <br /> <br />t <br />~,~..~3~.4AL ~_1+,n6eg. _. ..... <br />7f~. IMAp1.Y AT W®111~ <br />BAI. <br />. " <br />~ <br />~_1.QSi![•~r_ 111~ET Q9JlFA..NR - X1111 _ ~7/!Tl< <br />nonKMF MnMY1bn YM ^ 1W ~ .. x <br />Y7A WT! Di DEA~YI . Qbt 1!E DATE SgNED Ab OIY. Yf.l 8Ab TMAC OF pMTM <br />a ix(J ~ Q <br />( r <br />a+e DAT[pDRw <br />~ <br />~ aMYnr rn TWEOKap»~ ^7 <br />T <br />" 'y <br />~ 7k PRDNDUNCEDDEAD Mla.on~r rtn P~oNDINICEDDEM wAV~ <br />~ <br />r ~/ Z <br />•2_ S M a M <br />s s+r YOMb~wa"Y~~P. rsrrar,ew rr prr~daurglnr 7p. on~ewa..rw.rawa°a'a~+Mpwatinnw opiMm aNnaxun0a <br />ewraw aNrx a we nnr enr aro awca,ua dw N S»cw,.l.l «««< <br />apT antl TAY <br />E! DID ~iIIAS DRDAN GR TIyiGE ppNA71GN TE EN D+ A W NT GRANYED9 <br />p YES ND ^ Iw1DgwN ~ rES r( ~f o ~ YES ©+7~ <br />31 NAME qF CDRDNEII~PMYlIpAN OR CDYNI'YA 1 I p1b ..'~~ <br />Dr. Gordon J. Hrnicek, M.D , 729 N. ter. Grand I tend N raaka 6883 <br />m REOWTWM 7E4 DA S¢DSY RKiIBTAAP~ 11 <br />Please index this Death Certificate against the following described real estate: <br />~~ <br />The Northwest Quarter of the Northwest quarter of Section 35, Township 10 North, <br />Range 12, West of the 6th P.M., Hall County, Nebraska. <br />1123 W. Seaand Street Gr I 1 <br />Sa MAf9tl1TECA~IBE r CMI8EPE11LpAS ~M.Iq.ANDIEI) Irw/weMSrnawlAncawn <br />PMT ~ <br />y i <br />