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N~NTHiB COPY CAI~° THE ~
<br />SYSTEII~ IT CERTE'1ES THE BELOW TO BE A TRUE COPY OF THE OR/Q/NAt
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA TI$7
<br />i -a ~7 .,.
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS ~ ~ =- _ ~ ` -~- w~
<br />DATE OFR/SS,tryUMAyNp~CE - _ y; ~Y t~ ~ ~'-J4~'
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<br />201005891 '°
<br />LINCOLN, NEBRASKA HEALTHAND - ~~`~
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<br />STATE QF NEBRASKA -- DEPARTMENT OF NEALTN
<br />BUREAU QF VITAL STATISTICS T. •~
<br />CERTIFICATE OF DEATH ~, .,~,.~~~ 9 4 J Q~ 6 S
<br />1 11Ff.F.bfM - AMNF friST tAppLE lA$T 2 SEA ] pATE OF DEATH A4v/1 D>M' rrr
<br />_ ~% Female 1.994_.,,_,_._.
<br />• r71: r A11D STATE .. ....., a A Artl[gMrl L. AGE liM BAIONI ~ IAN t YEAR IINDFR t DAY i 61- OF eIR1M !µ`rp pW wl
<br />Bel 8dt. rrnl sstADS 1 wr, eGNDUR3 TAB Januar 27, 1925
<br />T svclAl sEwNTIY r PIAtE of puTw
<br />505-28-2536 K ^'°.." or~A [,~'""~°"°""
<br />' b FACiTTY ~ N,rAA Mnb1.A1FIaA-t P+MpMrwalnln~rl W v ~ ER glAprFw ~ ty,gFACw
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<br />I M.'Tle)~Lil! ~ « COllt/TY Of DEAM -
<br />'"` ~,] N, ~ Adams
<br />.. xGYY. TOMet DR ITICAT1pF1 -. ~., r! TANG IhYAlplr Gnnq MNSbE Gtr IIMIF
<br />ti w~cE~Ny,r+rteT.u~ AArlr,c~ArgAn , , 'arrows r
<br />11. AIYCESitry r,p IMMAn Mprr~,DM,IIAIl MCI is ~MAt111ED O W1pOWED. .1] NAME OF /WYr'-ArtlNn Ay'~F!'
<br />~ 1 rSruFC41 I$e/[/W
<br />is o t ''*'~" D Bernard Bockerman _
<br />t/i USIMIt OOLIlPAi10N /OM Anppwp+dwil AlNyny ltl K1IO OF Bilei1E8i 1N011$INY 1~ EDNT~1tCN 1. calAkA,q .~.--.
<br />I ~ atw'.wY Flt ~NwAN'MAIN ,.j
<br />~1 ~ ~ ~ v.TM % ~'11MY r S+einirr IC•t71 GOMI1Te 11 ] w .•,
<br />1{ FAT14R•NAME FN$1 , MIDOIE LA51 tf AlD7 fIRSY MI(]plF eIAgENSu11MLME
<br />a rick Walsh Lot a Whistler
<br />M WAS PECE/SED EVER M US AiMEb FOt1CE87 IM tMFOMFANT. NAERE.,,., """•.•~ ._..
<br />IY..annr,++y Att+rYFwaroadnarrrc„i
<br />rand ackerman
<br />lEb i1POfiANC7 MAIL 15T11FET ORRip FD. UtY pliglMl STATE. I11
<br />W Barrows Rci--Prosser Nebraska 68868
<br />sD E .9gn__ATt11MiEil1C I1A M[1MDDOftlgfpYTldu 211 DATE tlc GEMETERI'DRCNEMAII]Rr t1A11[
<br />w' ~ ~°~ 0 -1 Concordia. Cemete
<br />7~ 'NAME sti CENtETERY OR CREMAtDRr 4DCAlIbN pTY OP TOtYN E
<br />o - ilson F H. ~""'"" ~°v"'~"' Juniata Nebraska
<br />ssb FUNERIYL NDME AppRFSS 1$1REET OR RfD NO ptr pR lpNtV StA .~
<br />e--Kenesaw Nebraska 68956
<br />s] wEbuTE CAUSE IFNYEA ONLY DtE LIM15E PER 111E tpt w p, AND Ice I Mrrrr bM.IMI anw Arltl e.rn
<br />PART ~~~' f I
<br />TAI I +:a..-~+0 r ~-.f+^'i.~-
<br />pllE TO, OR A5 Af,6X+SEOVE 1 YarrM bMwrl ann rq MM
<br />OIIE TO, OR A$ A CbN5E0uENLE pF I ea.w hFIriFA rTrr rdY,yrtl _....
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<br />PANT OTHER SK.NIfILANT4p~p1gNS~Go~wns [pwpKrgbtr tMAW t./AW 1~IrAy PARt^KiEMALE WAS TIIEREA ?~ AUTOPSY 23 WAS fwSE NEFEfapEp ld MEpICAI
<br />M PRE6NAMCY el TIIE PAST J WbNTNS+ _ . E71MrNER OR CORONFN~
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<br />Tea ?Eb PATE Of eAAlm rAb pry n/ Iec McM1R DF tNAXtY sei OESCRI9E Npw e4A1Rr OCCURRED
<br />Acade.w ~ WWlernw0
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<br />~„J Su.cdF ~ Pi"~e".q 7EF ry,ArRY AT YYOtIR 1e1 vLACE QQFFM~tY %yY egrr. lr"i>i~N deter 18q LOGTIbN STREE1 pNHrb NO. GtY OR TOWN iTAtE
<br />LJ ~o~.cbr ^++`7~M Y~a.~ NF~ •bW~q aPVWI
<br />2TA pATE Of DEA7M. ,W Onr r.l sa. pAIE SIDIIEO !Mv pp rr r sEb l1YE Of pEATR
<br />~= Se tember 9.1994 M
<br />?Tb bATE 51GNEb rw Par W 1 s7C TIME OF pEATM sec PRp1pl/1DED OFAD rMr AN: n r 2ii PRDNDUN(,T p pEAD rAUV.
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<br />7f blbTgOACC',O USE CONTRIBUTE'TO TfIFOEAM.r 7DA FXI YISSUE OIYMTIpN e1FENCpt4gDEREb~ ]db WAS C,pN$ENYGMNTFD'r. ..
<br />YES ~ NO . ~lIt1IN0WN :...' ~ YE$ ~~ tPp
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<br />]111AMF ANb ADpRESS Uf CERTIFIER IPHY51CW40p1ONERSPwr51CMNdfNC®W171r ATTOfN4P-/lrprP~Ar'r._. ..-..-. .... ~ ....... .- .
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<br />navir~~~~3_M ?,1.1~.I~I. Kansas.--fiastinas. Nebraska 6$901
<br />sr, REClsrww .~T.-~ .~
<br />iIFD BY 11fG1$1RAq /Mb DN' n!
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