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4~ ~ b <br />~•• ~ p o a:; n n <br />~ CU fl'1 <br />" \ ~-t C.a ~-t ~ Z <br />W ~~ ~ ~ ~ Q c~ ~ ~ rT1 O ~ <br />CTt ~ ~ 3` e-i ~ r..- ~ C <br />~~ ~ ..r w ~--'~-1 <br />~rrr ~ ~ ~ ~ Z <br />'"~" O <br />cn <br />pp LOT TWF^1~1'TY-THREE (23), POTASH SUBDIVISION, HALL COUNTY, NEBRASKA <br />, <br />t, <br />~ ~ ~ <br />t ~ - <br />J. ~v/~ yy~Q~' i~ <br />~ .f'^ ~ + 1' 1WfIT ,T1WTy'ti~~ ~ ~ ~' ,S ~i~ <br />`~ =~ <br />.. .. ~~ . i <br />{'~: <br />,4~~,.,~, ~, ~~ STATE ~F WYaMING Y,~°~~. ~ ~l-i,l <br />DEPARTMENT QF HEALTH <br />~, 0 1 Q O 6 a7 ~~ CERTIFICATE OF DEATH i <br />Decedent: State File Number: 2d~ d-dd~4~J <br />Name: Garry Leonard Smith <br />Gender: Male SociaLSecurity Number. 508-56-6777. <br />Date of Birth: February 05, 1947 Age at the T(me of Death: 63 years <br />Date and Place of Death: <br />Date of heath: Apri129; 2010 County bf Death: Albany <br />City of Death: --• Laramie <br />Location: Ivinson Memorial Hospital 255 North 30th: <br />Addlt:anal Deced~nt information; <br />~' Place of Birth: .Stanton, Nebraska "~ <br />Residence: ':Grand Island,>:Nebraska' _ <br />Marital Status: Married -Dorothy Dobson <br />Armed Forces: Unknown <br />Name of Father: Melvin Smith <br />Name of Mother. Irene Lehman <br />Informant; Dorothy Smith Relatlonshtp: Wite <br />Disposition: <br />~ Method of Disposition: Removal-from State <br />j Place of Disposition: Grand tstand Cemetery, Grand island, Nebraska <br />funeral Home or Facility: <br />Facility: Montgomery-Stryker ,Laramie, Wyoming <br />j Cause:of Death: <br />The lmmediafe cause is )isted`an fire #irst line follow®d by arly,underlying causes. Interval: <br />(a) Acute myocardial infarction minutes ~ <br />Other Significant ~ - <br />Conditions: \ ~ <br />Manner of Death: Natural,Qeath Time of Death` Approximate 00:30 t1hr <br />Certifier: '.. <br />,: - <br />Type: Coror~r <br />Name: Tom Furgeson, Coroner <br />Address: 1'002 South 3rd 5t, Laramie, Wyoming; 82070 <br />Date Filed: May 20, 2Q90 <br />~~~~~0 <br />This is a true certification of the document on file in the office of Vital : /.~ _ I~..,_~-_ ~__ J <br />Statistics Services, Cheyenne, Wyoming „f'af !~J ~-C%J\,," <br />DATE ISSUED: Tuesday, ~1Ut18 Q$, 2Q~ ~ DeputyyState Registrar <br />Th~aopyi~nutvalidanlasr.prapauadon.psperwiAhanengr~vrdbonirr. - ~~~~ <br /> <br />r' <br />