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STATE OF NEBRASK/1-OEPAHTMENT OF MEALTMAND HUMIW SERVICES FINANCE At� SUPPORT ;;Z Z■�Z� CERTIFICATE OF DEATH -� -"-'--" t. DECEOENTS•NAME (flnt. YId4N, Iaft. Sulnz) 2. SEX 9.D�►TEOfDE�►TN 11N..OMr.YG) Pauline M Sorenaen Femsle Atguat 27, 2008 4. CtTY ANO STIITE ON TERN110RY, OR FORENiN COUNTRY OF 61RT11 Sa. AdE•Latt BIrIMryr 5p. UNDER t YEAN Sc. UNOER t pAY t. OATE OF BWTN (Ya. Dy. Yc) � � (Y�t.) YOS. OAY$ HOURS YINb. Grand laland. Nebraska 88 �ecember B. 1917 �. �oaa s�cunm NuweEa , e. x� aF o�� 507-14-0848 �Se17e�� rwar.m � O runno�rc O+�apo.Rao�i � ip. FACtUTY•NAME (It nol IntlltWon. plw stnM anR nnmb�r� � O ER/0up�tl�nt � O OuitlmtsMane V ' a Nebraska Mgwpdiat Hpgp�al O oo� O atrr�sp�apt � 6C. CIiY OH TOWN Of DEATH (InquM Dp Co0�1 6A. COUNTY OF DEATH � OmahB 68114 Do Ia3 Y� PESIOENCE-SL1TE m. COIMIY 9c GTYOR iOWN �. Nebraaka ias Omaha � 9dS711EETANDp1JN1BER 9�.APT.NO 91.LPCODE 90.�NSIOECIiYUY1T5 1715 So��th 96tl� S�eet 68124 0 rES 0 No 10a. WRIL►L STA7U3 �T TIME Of DEATM O Martl�a O WwrNtmW 100• NAYE OF SPWlSE (Rnt. MWtlN, Ut43uMt► If wib, pw m�iA�nn�. .. � 0 WtnW. bul MD�C ' � WMO�'W Q Onoto�/ 0 tlrlttNMe. _.. . . �__. . . . . _. . _ . ._. , - - . _ _ . ...... - � _.. _ � � .._:. - .: _ -- � . . - �. ' - _ . � . , , . �. : a N.PIITHER'S-NAYE (Rnl.� YidQq. .. �� Gsf. . 3uf11s) 72.IAOTNER'S-NANE (Rnl, Y190h, Witl�nSumrn�l � C.2$ �d�2tle M�elbBnbflnk 13. EVER IN U.S. ARIAED FORCES?� pM dtlN of NMU i►ya. 11a. INfOflMANT NAYE . � 1�0. Rf LATIONSHIP t0 OEOED6N? �� n... �. o� w�.� No Linda Mei s U� ter 15. YETHODOFDISi081T�f1 16a. EIiB�WIFA-SIOM� 18D. UCENSE NO. 16c: DATE (YO.. Oay. Yr. ) �"eulol OOoratlon $epie(Ilbef 1. 2006 � � �� ti' ° 160.CEYHTERY,CREWTOFIYOROTHERLOCATION�� - � CITV/10YVN � � � . STATE dR�novy O011wr{SpNiry) . .. ... _ ,� " _ . HINCfESt AA8rt101t11 P2rif C8f118�lfy .. - . ... . .. . � . . .. . . OrtlahB . . . . _ N�fi�1t9 . th FUNERAI. HOME NAYE AND YAlUtKi ADONESS (StrNL qq ariam.3hN1 1T0. Zip CoN -Owaak 3 CuUer; 78p51MG��r R . Omaha. PJebiaaka 68124 G A H{�• instructlons and axampies 1t PIWT I. EnMr tl�e � 4s�xa, injuA�s, or oanpMOYons-lhal aMe6y �w0 Ur Malh. DO NOf riNr bmirwt wmb wd� u qrdu amat � AMPAOOfIMATE INTER�AI �tprabry amM. avwdria�ar 11pMatlon wihad tq�iny M N61oqr. 00 NOT A8BRE111A7E. EM�r aiy onr ewq an a Am. Add aOaiMn� kiw if r�aarry. � M CaM15E: i aiWlbAMw aw W � � +"i...'�SA7 c �4Y.'i'e �r7d . . d�wvwn�lann�iln0 DUETO.ORAS CONBEOUENCE : 1 a�tbd�M MA�� 1 •.ar.+rrr �oeaado�.. r � ��w�!'Y�1�„ i •n.�oarrarrw�a ouEro. �coNSECUericEOF: i amxaa..n mrwa � EeY►MINDEN.YNOGINE (�w�a�ryhtlnNWN (� � hNM1YDMI�YqhOwy . [1uEM!11t�¢��!f�l4rsA�1CMCCpE. _ � .. : .._ , . - --_ . _._ _.l.�a�lNMdl�1 . _. .� � _.: . � � � � . _ . . . . . . � .__ . - � . �. . 4 . _ . . wl ' l� � � F"a � lV w i 1 � 18. PAtiT I1.OTMEfl 81GlUFlCANf CONDlTWNS-CoiqdOnt ca�hlbWYp M IM dan q/ n6t rMINq In Ihe YWMYh�Q eauw ylwn m MRT 1, i! YYAY MEO�CA1.fdfAYNiR. � � � � - . � . OR�CCROelEX�6 . . 0 YES iQ NO 20.IFFEYALE 2h.MA OFDEATM 210.1fTRANEPORTATIONlWIfNV p1CWASANAUTO►SYPERi0RYE0'� Y7 tat a.qwr,.�amvar.0 �wwai O�omaa Oaivwow�aa O►r.�.M ai um. a a.n O �caa«r0 ��ron � P°�"'� O rES 0� � O nocpo�wr,eura.qwar�rn�ay.ad..n ❑suaa Ocouanwaw�emr�w Ov.aa�an z�aw��uraPSVAta�wsev�ro I O►�a�qwK,ator.�rrntpu��rs�oirwewa.aan Oon.rfswa�41 c�te�aFOE,a►r� ! Oa�tnamnpnp+.ntruw,nwQ.a�r Oyes awo 2ta. WTE OF INJURY (Ma. Dhr. Vc� ..�: � Y14: AME Of INJURY �;ZC. W+ACE Of IN.FURY-�(hom�,tann, str�N; flpDry. W�a buldrp. cpatn�ctlan ff4. Ne. (sWph) � .. . � � - m I o . �'" 226iMN1RYATwORK9.... . 1�.�oE9CAl0E11oYY1tuulnOCCtlHRfeD�� ` .� . . . . Q CES Q'�0 ° � 2�LOFJITIOMOFMWIM•9T9EFiiR!!!MBER.APxNO. qIYlIOMM 3a7E ��OE � R9�. L'M7E Oi O[aYM (Ya. D� Yr.► � � ��. bti. WTH �tGNEO lYa. D�,Yt.) 241-7pECF OEAtN � 1 . 3� r1L�1SSt 2�, zQ� ' � rt1 � � r �.DAiE NED�p.,GtgSWJ l9�TII�EOFDEATN �� ale.PROfWUqCEDOEAD(W.OqLYc) IM.T�ErRONObNCfDOEJID � _.. - - m �`,.<� � � m ' � ' �a n� �n.u�.dwma a au.onn.ea.aaamina«► �rw��t _� ,� - ane a.�� a �s�.�w-zwe►♦ � , ' o � n.Mq..au..naara,na�w� �r�.�m�rwwananw4♦ ;. � __ _��.- "`____ _:. _.- - ----- -- - - _ . . 75.OIOT�09tt:,^,pU9E'OOkTRitlTlTOTNEOEAiMr 2q.HASORO/WOt1T�8UEDONATIONBEENCONEIOERED� 260.WASCONSENT6NAKTEO� O res �,;.� O r�v 0 u�rtp � rEa �+�' ►w�,�ar� n 2i. r No O rEi 0 wo Y7. 111�1 "w`NN�J?A�NEltJfCE�iIFi�'RIM11/31qAt1.COROMER'SMn91CNNORCAUN7YATTORI�Ytt�lv�«�) Dr. Stewen E:f�liams M.D. I0060 Re e� Circle Nebraska 68 4 i. I��BTp11NE $IONA7Um1E 2B0. GNTE FlLED 6tl i1E61i1MR (Mo.. OM.'�N � � _ ,,.� ....."' Q g � I TRU� CERTIFlCATION OF A �ECc�R� t?N �'ll F �'�1T�� � SFP 12 1006 . �. v�ra� sr��s��cs. ��u�s � C''�.,,c'� ca. r��. r� ��:� o�. a� �a�s�