201003875 - Laserfiche WebLink

Browse

STATE OF NEBRASKA WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTM~NTQF HEALTH-4ND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE"O)WGINA fj~CQRQ 'ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN ,SERVICES; VT-TAI -RF11aCOf2DS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. DATE OF ISSUANCE a iC.) &T°ANLEY COOPER APR 0 7 2010 201003875 A*j5tST4f~,T 5' -,4Ti WGI~ST2A{ , PL?PARTMENT OF HAS TM_%glyP " LINCOLN, NEBRASKA HUn9AN S }VIC r'. ~Ti~DT]FaW►JiAIeuMlA~rfi~rA1?' r li~c'14A~'r (o++s.AJ.iI Joce1, NMI: Sipple F& 02)2 mow, a --ff wMpoF York. Aqw Nebraska n.b.mr~Y3 1A A111, L"004" , r an 5c M u n~1 , z r~ ?x~ 5D6TQ4 5018 11osF1rAL El Mr*b!'M"a J . au1.rMA~~ ~A4Aw AAO ❑ ~i1!+~+A9~'q { 1'` Fy . rri Square ~etre CiOnter 9 n Grand sland belt ka' - 68 ❑ ODA Q 4Kr 40"w f (MY.TQ M1011 OF176ATN . !d r4oe;arv"wm. M. COLIM,OF TH Grand I land rar . [j ftil 1 lw'-qF^w m. coomm. ic..CRY. TOM(" . L=Rlk 'VM UAlta F'!AM~+F7fA - Nebraska Hall Grand Islaw " TA. ftmp- -Is0.TMuk amok-. 66wL Ill.,%%pESTgv MA-A1FAR. QWWAMOXJ 1 El AWM11W 1$' - wNclrKw~fM.►iR!!K'. - into A3B i an Cuar] as le T.M' Lt%ft0=0AMN l~erwl.w Mnro,.iorwar tAb. AM OF moDM V ti Etllk - aw+uF!!r , - , ..Ar+wwAta wArl f3~R#a H aweaker Domestic 1a FATIim. MME FOW MOOL@ LAST 117 uDTHM Irv Harden V" 00MAW CAW M 1[a Al Y!a •A" No ChaXlps to IM AGAODW-M 0TRFETQA".C.1A0,dfYpnT*wK ATE7/'y 512 wet 15th Str& t 7n MBNA7rAE•t1CE+lYE1q trIF Rum A OFoaAwt.or1 p., g. Ztc ~ Not Embalmed ❑ ftw ❑ 1rww 02/23/02 W1{s lawn Gr =L fkaiu how-NOAE bd CV*T4 nRCJAAMT0WU-A1WW pR1 saw Apfel--Butler-Geddes Funeral Hen Ei ommo ❑ap"- Grand Island Nebraska M FUNWKNOWADDIe6 15TWE0 CMZ.ro.CMVas .srArL*- 1123 West Second Street, Grand Island, Nebraska 68801 m MAIDMTkc^mK 1anwalivOwG7Am Lvafcmr.OLAW*# ~rwwl +Aw .err e N pVETQ AiA CO A NIEWENM OF M r 6T an AS ACCftK VWCE OF i AliArdAi,rrAwTwWAyMti1 ~ a rA~r CDMO~►1dr4 - fiA1Mw~ w~wdAwp a M rriw er wwd ►Awr r A[ig1E wAi. A A~ wNAi CAw♦t, FNECMMw-v a M AAAT 7 Apryr116W MrAAwA"(~! 7AAA. re-&% ,Vi. f-I Ae Ws !M. no M OATS OF owns Awb. aw wJ Nc NOVw Of *LRow 74 MECUM[ HOW SAO" rl '"m QUMM" ❑ Axsb~+1 ❑ 1A.1.iwnrw ❑ %.a ❑ poke 7M AAAA7r AT w01M 111 Y - dlrA1Y-Allw~r t~nfiAN M1~r YN l.4L"r1Tp1'1 PfmTpptFz&* dryooftaY 'MIME' ❑ ♦M4dAAn Yw ❑ Mr ❑ DIY TE 7M AMr. lA w/ AM m 7f aw iv 6 y tJ4 GATEMAM[O Ap a1' M/ rn TWOFMAT" ~ 91t. AF[1MOM1C~OiAO ab GAF: *0 A11~.{fA0 /Aru 'A q ~i t M S 4TA le VgiAA1M M1 «a ball 4L ]fir O. Any Awwgw,rw'r~r.A.w-FwAnN~+M+rilrPa+wA~An 4-wow vm A a vw on -mom woMr@w*wmw"4wm T AF LiM YpiACGp 111E CaMr1MVr['Ir1,ME OFJ1rh 70A GM TgiVE OGMf1gN MEEl1 p01Wp~1Ep, 71111AAAiC01MMIM 40 uhnue)m ❑ Ms ❑ vft A AwrE AAp AYf/~x OA rnwvlldAM COA'JE11 s nrr~,'rM a cr.)11111'r ATTCNYEVr 1,w s ►r..s Dr. David R. Colan 729 North Custer Grand Island, Nebraska 68601 >a ~arrwAw all, 7F11 onenEgrr AIM. ,til ; FEB 2 8 M