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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE R,4ISED SEAL �� THE NEBRASKA bEPARTMENT OF HEAL
<br />THE BE40W TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRi9S
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WWICH IS 7'HE LEGAL DEPOSITORY F�-�/�
<br />DATE OF ISSUANCE
<br />JAN Z'l 20�1
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<br />STATE OF NEBRASKA- DEPARTMENTOF NEAL7M AND HUMAN SERVICES fINA1�E AND SLIPPORT �"` �*���"`a ',"` �
<br />CERTIFICATE OF QEATH
<br />�. DECE�ENT•S•N�ME �FiiH, Niaai�, usr. Saaiq Z, 4Ex 9.DATEOFDEATN (Ma.Day.Yr.)
<br />William G. Plwmner Jr. Male February 3, 2007
<br />4.CITY AND STATE OR TERqRORK QR FOREIGN CQUNTRC Of BIRSH Sa. AGE-l�st9tnpdsy Sb. UNDER t YEAR�' Sc. UNDER 1 DAY 6. DATE OF B1RTH �MO., Day, rr.)
<br />Grand island, 13ebYA8ka � 83 Mos. o�r f MouAS MINB, MSICIl 6� 1923
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<br />86. FACIL�T1!•NAME pl not InttRWion, yWa strotl an6 oumb�q ❑ ERtOutpa7i�n1 � 0 Oa�dmCtlbm�
<br />St. Francia Medical Center �� a ����
<br />aC. GITY ORTOWN OF pEA7H (InUud� Zlp Cade� � i0. CAUNTr OF DEA7lf
<br />Grand Island, 68803 Hall
<br />9s.RESWENCEStAfE 9htq11iry � . 9c.CITYORTOWN . .
<br />Nebraska Hall Grand Island
<br />9tl.9TREET�NONUMBER 9e.APtNO 9f.LPCODE
<br />1615 East 7th Sc. 68801
<br />IOt.MARITALSTATUSATTIMEOFpEATX ���rried ON�w�Mirri�d . 10D.NAl1E0F5ppU5E �Fint,Mlddl�,L»LSuUi.INwn�,9ro�msid�nn�m�.
<br />OM�rcyd ,w,,.,p,,,,.0 ow��.e aowo�ow ou�w�o.� '� Madeline Bi�gley .
<br />tt.KATHER'S•NAME (Flrsl, M�Ad4, . La�t, Sultli� t�.MOTHER'4•NAME (Ftrs�. MiAdb, M�ctl�nSurn�mq
<br />William Plummer Bernice Hilty
<br />7�b. RELAT�ONSHIP TO DECEDExT
<br />Wife
<br />f 6c. DATE (MO., D�y, vr. 1
<br />February b, 20Q7
<br />SiATE
<br />OC�emalian OEmombmanl �6d� METERY.CREM R OP ERLOCATION CITYITOWN .
<br />O�mwa� ''JOtnerlspecnyl Grand Island Cemetery Grand Island, NE.
<br />�3. EYER IN U.S. ARMED FORCE61 Gir� d�tuof teroin il Y�s, p�.INF0i1MANT-NANE � .
<br />(v�s,no,o�unk.) No . Madeline Plummer
<br />16.METNODOFq6POSITION tBa.EM&1 R- 6 � 16b.LIGEN5EN0.
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<br />17a FUNERAL HOME W�M6 AND MAIIING IIDDRE53 (SIrNt. CMy qTOwn, Bhtel 17D. Z{p CaO�
<br />Apfel Funeral Home� 1123 West Second, Grand Island. NE. 58801
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<br />37. NAME, 71ttE AN� ADDRESS OF CERTIFIER (PHYSu
<br />Steven L. Husen M.D.
<br />2l�.AEGISTAAWSSIGNMURE �
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<br />2116 West Faidley Ave., Grand Island. NE. 68803
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<br />HHS•81 11I03(55061)
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