|
STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT DF•H~ALTH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ~~~ -4R~'~4~RD QN
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVl6~, ~T~L~F~E ~;~r~r~s
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECpRDS. .. " ~~~ `~ , • ' r~,~ `
<br />,~~ ,, ~
<br />DATE OF ISSUANCE ^~~ ~'
<br />NOV 2 3 2009 2 U 0 9 U 9 2 9 s r~ .~AS~r r s~~a~ REC,~,~aR
<br />t' ""'C]L4''P., N~~~H~AL: :APCD
<br />LINCOLN, NEBRASKA ~~~ ~~N{JM ~I;~~.;- ~ ; ';
<br />r
<br />sTAi8aF1~EU1A>ptA-oiMR~MIIt~~s~A[.711~-irp11l1NIANS~tvii~Spl~IAt~,A~ i r ~w'~'~ ~,~,~,~ .
<br />CERTIFICATE OF DEATH a ,
<br />1 OECEDpIT • RYE T NIIDDIi T Z ^ A DATE OF OEATN~ ~-MTark Q/Y• fili
<br />
<br />Lsana Ann Gebers ~.
<br />Famale Se tember 12, 2004
<br />A. A/tl STATE OF SM7TM A1,N/pU&A A/I,Up~'/ MADE-IAN MrI«y UNDfr1ll YEAl1 tOAY IDATE OF'gIRTM AMyIUW. YAFI
<br />Rural Grand Island, Nebraska `~`~ 71 M ~~ ~. r»Is December 7 1932
<br />7 SOCML MUYSER M. MACE OF OFATN
<br />505-38-5825 "-°eqT"` ^ "'o+r" °"~a ®'+ww.°'"""
<br />FACVTY•NN•r M'nw irWApA V~MM/rtltiwM/J ~ ER OdOtl~IM ^ R,F,.rr,,
<br />Beverl Healthcare Park Place
<br />"' ^ °0A ^ p"r'
<br />k aTY TOWN LOf,AT1pN aF LEATM
<br />b M cDlr+rv DF DEA
<br />Grand Island ~ ®~ ^ Hall
<br />w.' iIDl11CA1- $TA « COIINYY 0¢ CITY. TOwN OR LOCATION M STREET AND NUM6ETi A71cy11RElpCa~Y M NISIDE
<br />Nebraska Hall Grand Island 2418 N. Huston 68803 Y« ~ "~
<br />w • NS. W11M. A1n/M1Tr1 YItl1.A. 11. ANCESTRY lep. OwnlYt Mal t . ®MARREO fIADOMED fi NAME OF SPOUSE w r+Y. PM.N1cM~ err/
<br />~,~" .White I German/American " ~" °NOR~D Edmund D. Gebers
<br />TM USIML OCC1MATgN /aMAil,d.v~a,aMlrWrwp nor lA,. i/iD OF pUENE$B IIIOUSTIIY
<br />W wa'MI"iMk nwI/~w,A 15 EOUfa-TION (EMGM CIMIr
<br />
<br />Secretar /Bookkee er 6as Station a Wt4) CC119e ItibYl
<br />th Gra e
<br />x FA .NAMC F,9ST .,ppl,E to ,r ,roDLE MAID[N
<br />Armin F. Dankert. Li11an A. Schobrin
<br />4' YTAB EVER W U.S. 1M . NAAE
<br />IY«.roaultl *Y«Vi+AwrlgArNAIIFaWN '
<br />No ------ Edmund D. Gebers
<br />ue MFORL4ANT MAILING ISTREET , rnr A
<br />2418 N. Huston, Grand Island, Nebraska 68803
<br />>b. 7 i q 91i MLTIgp $li pATE 7+C CEIAETlIIY OR CREYATORV NAME
<br />~ ~
<br />~l/~ [7~a.lr ^R,mewl Se t. lb, 200 Westlawn Memorial Park
<br />?b NOME • ptp CEMETERY CIIIMATOi11' LOCA CITY OP TQIMI STATE
<br />Livingston--Sondeimann F.H. ^ ^~^ Grand Island, Nebraska
<br />FUNERAL SS 1 RF.D. Np. CRY . STA
<br />I 601 N. Webb Road, Grand Island, Nebraska b8803
<br />+urOuTE GUSE n*.NTea Ow.v aNE CAUSE rta .u rol. ANO kN ~ Inrw oMrl,n nlrr ra a,Rn
<br />X ~ BREAST CA COLON CA ;'~ 3 MONtHS
<br />DUE TQ OR A$A OF I YAwvtl CMl'„n pl,/IrW tl.rh
<br />I ;
<br />pl ~
<br />A
<br />DUE T0, OR A8 ACANSEOIENCE DF ~ MINrYA1 Cririll Or11 AM tl,R1,
<br />I
<br />k1 I
<br />^
<br />a.. ,~
<br />^ ACCgI. ^ umlwmuleu
<br />FREONANCT NI THE
<br />YHOID ATRIAL FIB uo»,o-sa Yr
<br />E of EiiIRV Ai+, dY• riJ aEc. HOUR aF NLIIMY Zed OESCRMlE
<br />^ WrtO ^ wCC"'9 PM. AAAIAY AT YA7iM( lEl. P~I 7EOF NaN~Y•At llppi,.
<br />^ I•u~.c4r I,w,N,MOn Y„ ~ ~ ^ ~'L /APw'+1T
<br />27i DATE TN Ab.. GMF Yfl
<br />I
<br />I~ Se tember 12, 2004
<br />~ aTe. DATE s>ONrer /Mb Ow Yrl an THE nr DEATH
<br />~~ * Se tember 13 , 200 ~ 05:30 P.M.
<br />~+TO nr Mrrmy Nb.NeYr.a~IxwnerlMwlli pAl «AANb111,
<br />~ ~1 ciY1MN ARMd l1 _
<br />.Z- ^ YES ®NO ^ UrNKNDYNI ~•~ .
<br />a,~ ANnr,, sioc t.NY~&AN,«asw,Y DRCOam
<br />~__ Dr. Larry Han$en, M.D., 30Sb W.
<br />M
<br />Mar. YcMY Il,. LOCATION
<br />'~
<br />S
<br />d
<br />~ LJI Y« L. I ~ I~-II v«
<br />CI7v OR TOWN
<br />HEAD nra aN: n.l I ira MnONOUNDED DEAD AWvi
<br />M~ A rr~ A M~IIrIMOA,IiE q I1MM,Mp4 a IIIr,,.M'J~I OMtl~ CkC,.NO•
<br />h I.qi dtb rr C1iW iM tlu. pMewyrN.IIMd
<br />^ YES ® ~ ~ ^ YES e9 No
<br />IINEYI /no.dn.Ir
<br />:idley Ave., Grand Island, NE 68803
<br />DATE eY REOI~TRAN ,M,. Dw. nr
<br />SEP 1 52004
<br />
|