|
. . ,
<br />STATE OF NEBRASKA
<br />«�,,��"..�.�. �:
<br />WHEN THIS COPY CARRIES THE R.4ISED SEAL OF THE NEBRASKA DEPARTM�"f� h4' T
<br />HUMAN S�RVIG�S, IT CERTIFIES THE BELOW TD 8E A TRUE COPY OF TH�,;ORI�1, ����; '
<br />FILE WITH THE NEBRASKA DEPARTM�NT OF HEALTH ANQ HUMAN SERVF�'�,�KVIT�� ,�� �� ��
<br />OFFICE, WHICH IS THE LEGAL DEPdSIT�RY FOR VITAL RECORDS. ,m� `.''� �J
<br />.� � ' "r,+
<br />DAT� QF ISSUANCE � " ''
<br />���11VL � i n ...
<br />�EC 2�2o1Q 2 Q 10 0 9 7 9 9 ���r�r,� ,��T�a,�
<br />���T �vr � �,�`� ��r�,�
<br />LINCOLN, NEBRASKA '
<br />N '�N����� � .�'� ��', .._ ...�_._..._
<br />i 0 �1 `,.��+''. .•... , .a��a� .
<br />� ,/�' �, "�" t r' ,,,�
<br />�rrauta►t�r�wtM�lwu►s�ra� � stvKapt�i�1��. ,,��
<br />� _ w-
<br />�SRT�CA'l� OF �A'�'i�!
<br />,
<br />�au1 liilliapd Johr��ar► M�ala l�rch 28, 1998
<br />.wwu �-+wwww . -1+� , + � .
<br />Chi�aqa, I11. � �' 65 � �. t�arch 29 1932
<br />r�
<br />506-4b-6747 " ❑ "°"�" °r� �] "�.""'"�"�
<br />.,r,,,, r�r.rww�.s�+.�.r...ww.N ❑ �"°ww'� �] ��.
<br />3�� W�B� r ?Ct1 �4V�I1111N ❑� ❑ anri�ca�
<br />i rn ,�a Lw►rh 9r ou
<br />+"� pJ "° U na►wsar�
<br />w'�`."��"9� a�► �wo wr�asa�
<br />N�braska Dawson �umner 03 Viest 5th 68878
<br />•aw- �r�c« ra�r, ,,. �r.o w�r. .�a �� Q ia ewu[areroueE n+w+rw�.•ra
<br />Whi� � r� "'�"�" °" Zola Mae Davisan
<br />IN �ODCWMnOM� w�fA�wrRAaro.e4rynur , 44h KMpOFM10111ES6WSl:5fAV O t` 15. EDUCATpN 1 aa�M
<br />�'l 11r�WlrwbYOelltlrv10.1l1 QM
<br />Farmer A riculture
<br />! FA •NM1E ii�6T 1NACLE fAB� 17 ApTWIII fM16T
<br />P�ul Jahn�on Beulah
<br />�0. OE"�8E0 EVER w U S. P f 87 +0� ..
<br />rr�..�w.nw�1 lMres.aw.wa�l aawMas�
<br />Yes �orea10�9�52 tia 9�21�54 Mrs. zola Mae Johnson
<br />iw �ss is�e.sn No.crtronTOwN s'r�re av�
<br />303 West 5th Avenue� 8umner, NE 68878
<br />� 10 BMBN.I�R � TUi16 t 6�E N0 '11�. Mfl1b00F Oq�GS�T�ON 314. DATF. �
<br />�� 1199 � �,,,,, � „„�,,,, Mar 31, 1948
<br />x. � wo�[ • wnr� x,a ct�r�rr' o�c�uan
<br />Horner--Lieske—tiorner ❑�^ ��^ 5umner
<br />!�p o� Aod�E �sraEEr oq p,s.6 wo. arr qp oWn�. sT�Tf.2w1
<br />2421 Avenue A, Kearney, N 68 89'7
<br />!3. !N!!E41�TLC�L?5 �C�+7EnOM.vpNErJUSEPEx:A�EFOA�ai�elANatcfl
<br />PAAT
<br />�,,, Casdiopulmonary Failure
<br />W OR AS A COpSE011ENCE � � � .
<br />�ei
<br />�� DUB T0. 0� AS A CONSE9l1ENl:£ �7G� . — _ — -_ — _
<br />�4)
<br />� Immediate
<br />� ����
<br />�
<br />�
<br />� MM�vMMwrnawt�
<br />i
<br />AS. WAS CA6E NE�FED 1
<br />E7fA�11NEfi Oil CQRU�4E
<br />rw7� rw
<br />6:aQ a.
<br />11NCEDDEAO Pb�rr
<br />6 ;���,
<br />WuM1616�MM. ..'� tl�l4mi. dMro CMMIfIWM0.\ .
<br />/j
<br />1 uW T� I TdN
<br />!Y. pID TOpACGO USE GONTPo9lJtE 10 TME OEAMT 8qs MAS OR6M1 pii 716SyE ODNA71pN pEEN LON&OEAED� e W �SD° .�
<br />� Y�5 � Np � UN1tNOWN � v�y � Np � . YE4 NO
<br />It NAME pND ACORE$Si OF CEfiTlFlpji iPMY$ICIAN. ROt�ER 3 PHVSN;NN Qq CQUNTY �7TpiWEY'� �. iyps Cr Wmf1 J .
<br />Rabecca Harling, Deputy County Attorn�y, 700 N. k.-shington, �.exfngton, HE 6$t
<br />p � T OtMER (rONpT10N8-Cip1tlNG�W�CWq1oY1lONN�hulnpl�NlNO PF� N�NCYNITMfPA57�M�1Y�11$� 2� MIfOPSY
<br />ON
<br />" D1abeLes , . r« � �� �
<br />aw• o w
<br />�a.. ��A see o�rfi oF n�uu�rv r� o.r. w.i � Houa oF auuav �ea oescwee rqw Muupr xcurweo
<br />❑ k�" l"� '�^� N A N M I N/A
<br />{� 9�cq� ❑ Wrq��9 7M. W,NR1' 11T WOfi( P!� �0� Mc /�.cy/ .!MM aMM nCbY �il. LOGATqN STREET OR Rf O. NCl
<br />❑ .��. M�. /Ac•�❑ ^� ❑ N/A� N/A
<br />871 DA7� G� DEATN /Mb OYV 17l . , 2!� QI1TE �N[9 %Ab ON Yr l 7!
<br />1Karch 31, 1998
<br />�� � Z)b. 4ATE 81f3Nfi6 f116 MY. Yr � 27c TIME CF qEATN ���+ � 74C PADN01r�Y0R , AA rAW .. .l
<br />M
<br />" M�Ech 2$, 199$
<br />°� 47A. TDIM4qtElrryMntl.NtlW E�rnocCWntlNMkn�.dNMqP�MddwronN 3� 4M CM��yqpH p ri
<br />w. b( 1 �
<br />�trd
<br />�e �a+tunww
<br />Cramer
<br />rc ccr�E�ERrancnEwurorrv
<br />Sumner Cemeterv
<br />
|