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STATE OF NEBRASKA <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF~k~Eclb7~lkt W <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORI6r9'tY~ ~~P ~$ ~ , <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICE.S~•'~/I~TJgL~~•R~COR~S~ ,,,, <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. ;.,.• ,`~ , •' ~~T ~ • ' • ~ :~, l N <br />w .• <br />DATE OF ISSUANCE ~" <br />MAR 1 2 20iD ~ 010 01 ~ s s Ar>4~ ~~ ~ST~t,4~? <br />D@'PAIaTMENT:QF HEA~~ ANL~~• tl~ <br />LINCOLN, NEBRASKA HL~MA~'f, SEF~rVICES <br />S1A180E1~R/WC+•1np'A1t21~IfOFCfPALTNAIiDIRJMASISlR11X'~'~ ~ fr '. <br />VRALi7wi1~11Ci ~ ~ F ~, K <br />C''~TII~'ICA'~B 8~F 'R~t ~ ~ <br /> <br />A .A*NPd~yt -1+IN ~ <br />BYiason Neb~ska, nwI 74 „ _;~ a <br />26-26 i a ngerTTA,t: (~ •srNl. a,~ Q w,rn,4.M <br />•wa. IrAr ~MMItlfAlIIAlA1YM1 ~ ~a,rrrlN ~ ^rprlrA <br />St. Francis M®dcial Center ®°p" ©~•+rr~w <br />_ _ . , <br />_ <br />~ ®~ <br />~ <br />Gtend. Island <br />. sr oR <br />Nebo Hall its t +w . ~. <br />• tt~. W11N~. ~I1. AN1.11[~tl tel. ,,, RY I.,. «~~ , <br />"" ~°'"" White 1°~°"" 14merican DwoRCx~ Waltcin ~+. <br />t.-U811AL OOpUPATgN I~t+MdwAaprawNanlpr tIb. IVNp OF EU~l6S NVDUSTRV to ' <br />.., <br />dw~~v, At Mll lAT/tlW <br />M~OI . <br />Buildill & I~OZJ11 1 <br />ti. ~A -IM1E 1AIDDLE IAST 17. M1DTI~i <br /> <br />EVNTI IN V.S. 7M~ . ~ -- - - ~ ~ . ~.~~_.~. <br />ra m ~wct ~++atw+••rwew.atwue.u <br />~ Walter P. SxawCl <br />IsTtt~~r D ATl.~ <br />31 t~~ood Circle s 688 1 <br />• ~ MD. A. $t TE YIa t: q! TCAv. <br />®eww ^ R~movp Oct. 7 5 7 999. Wcstlawn Me~oar; *~ ~ P&~C <br />tl Cd1R7i11Y OR TORY LOCATION CR TiD1Al11 <br />Kleaxie Home ^ °i"°^ ~ °°""°" c~and Is].ar-d Kaska <br />MDME RC~D~+E IS OR RF.D. Np.. CtTV OR TOWN. A ~ <br />X213 W. North Front St. Grand Island Nebraska 68803 <br />TE CJ41RE IEARER OIILY ONE CAVEE PEa LPIE FDR 41 Iq. AtrP kN MllrrrlNIERIP~ WItlMiMA~ <br />PART 1 <br />1 <br />~e , <br />~ <br />1 <br />bVETO. ASACgNBEOVENCEOF~ 1 rIYM'iANNW~ <br />1 <br />!~ 1 <br />DUE TO.OA ABACON$EOVENCE CF' 1 MIIrM tlMIMR pMii lVtld~~ <br />1 <br />~ <br />!~I <br />TART OTgCR CANOR101lS • CYRtA01A1 i~411N11010 iM dNi/1 tAlt 401+MAM0 PART 111 ti FFAIN{,E. WAS TN(# A AUTOPSY V/AS CABC TI~ERIIFpTD <br />E PR~11V1CY iN T11E PAST 9 AADNTFi$'+ E%ANAl11ER dl CL"ROllpl° <br />Pla{ tp.'$q Yp ND YM No Y.t ' NP <br />ae. zen. HATE as NAAAtr Mp.. 4r. nr 9ec. NDVie aF /aA/pv qw. bESCRiBE Now PIAMY OCCURRgf <br />^ Aeetlrr ^ UnpppmeMtl <br /> Y <br />^ Sum ^ P.rlyq ~. N+UURY AT WOpf IEI P~ACEOF~LA~h' ~A1 fq~.lr!n. y'M~ tEeldlr Nf9 i.~CAT10N STt1E[T OR RF.D. ND, drv OR'-AWM tiTATE <br />^ 110rndtl~ MwagYan Vr ~ Ilo ^ ~ ~'R'7 ' <br />. OAT(OF pEATN Ab Op v ~ PE. DATE OKP1E0 (M7 OrY Yrl 7~. TNIE p DEATH <br />O ~ <br />6 <br />y DATE. A4.. dEY, rel I7C 1tyE OF DF,ATN g ~ ~ qle. PRDR01M1GED DEAD Mb. Dlb: n.l Ld. PRDMDUNGED gEAO Rbvr <br />'~ 2:18 A ~ <br />'~ M s ~ M <br />,aAU Alltl pl/p Md dllbX~e 8 <br />7 WIdC Yrowinlp~. ocC~rnp 4N, C~IIMh/r{p~tlgllMW~afYW~y~e11y 7P~~71t,O~0EEtl14^ <br />~ <br />~ <br />$$$$$$ tlr Knr.aw Altl pYn AAtl ArtlNgetiolElp ~6 <br />TNN <br />Ol0 TCMtx.O VSE CONTgBVTE TiIE DEATNT NA$ ORDAN OA TISSUE DONATN]N 9E rd <br />ETt CDNSpEgEDT WAQ CdK6NT V11AtiTEM <br />s. .... ~ .ES _: ~ .~~.~. 4UKNOWW ._ _. _._._.._. __ __... _. .. ~ YEB ~ Np ... ~ YE$ ~ ND - <br />Cert. <br />