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Death Certificate - Henze, Sally Ann_11/23/2004I s:�.�.e.�.,,o�_.�.. _, , -_: -n ,� : �, �.. ,�x �� _ • � • -- :�:T-��=��� � 4 �. . � . . -•��t� �t�� WHEN TH1S COPYCARRfES TIfE RqISED SEAL OF THE NEBRASKA HEALTH AND hIUMAN SERVICES ' '�f '`t'' �� SYSTE6� /T (�R7/FlFS THE BELO W TO BE A TRUE COPY OF THE ORIG/NAL RECORD ON FILE WITH '•-• /� -+-- t�•: f�: THE NEBRASKA HEALTHAND HUMAN SERNCES SYSTEM, VITAL STATISTICS SECT/ON, WF11CH IS '��� �;�1�� •_�;��� THE LEGAL DEPOSl70RYFOR VITAL RECOROS. � /J '� �� *.?` DATE OF ISSUANCE ' j�� Sr �"° "0 G�. .-. '�-'- i i..,._.i�� , ) ... 10/15/2004 a �s.cooPeR � �- � . '-��t: LINCOLN, NEBRASICA � ASSISTANT STqTE REG/STRAR - - . - �— - � � FIEALTH AND HUMAN SERV/CES SYSTEM. � , -, __ � '-'j ��� STATE OF \'EBRq$i;q_ DEPAR77,1{E,�7 OF F�pL'[}{ q,�D H[J.4tq,Y SERVICES FLYA,\CE AND SUPPORT �uSTA,�„�s 0 4� 10 5 6 0 .:.; �� CERTIFICATE OF DEATH -•- YAME FI95: W9DLC y " USi 1 o c .. ._ _ .. �T./�111 Jptllpyl�,�yy '�'= ��=�Y� UNCciIYE]P � UNCEq10�Y �6p�TEOigIq.- IVx!.WvYUy (Y/11 5¢ MCS � !LVc ' I � September 1, 1940 eo,_rN MO.SPfAL ❑ NGa:ev Oi—..c� ❑ NurHaNSv � 'eri MSaM � P�s ee � �A � Ov�olSxn� iVl1Vrt5 de CWNTVOFOEAin Kearney � �_ � w ❑ Buffalo siaESio=NC_-s:�tE soCOUrr�Y 9c.eitt.rOV.�YOR�OCa;qrv 9es�aEci.WO.wN'e'e=MCicbSZmCSe> >ewswEaiv! ColOrado Larimer I Fort C011i � w��+wEO I� O�o � oage NSeorswos_8-- ��.+.>...-al n,,am�CH w 0 CE�g.wrc�9YC Yqa I CES ley Me.sa�Gerr.ytee� i2 � i is�'r is White �`�rtierican �"�'E� �—j�o�E� Richard H Henze JSU'lOf,CU iq. �G... dp qxaa'�cwy <„ :yVDOF3U5N_SSWWSTRY �15 E'JUCnipN ISxC/wWnqasgactcmide:r_I o'��ovMUe.nmlins! ✓Nllrse --..... ----� � Home Hedlth �AC�[nin. - I� ��""r°s«�„w-�r -- - cmce.:�..as-�- 16 FaLHER-NAME FWST i.uDplE USi t] u0:-_a FIaS� . Hubert E, Ward Lelia ie 1s oEC�s�o evEa w us uauEO �ox.�s� I�w. �.:nAwwr.x.w=_ 1�'x�o.av,'..� I mr�+s—.y,mmmazmin� �iO Richard H Henze 19p WFOPM.�NT u4RLVGAppaE55 ISiREROFRFA.NO.GttORiOWN,SinTEZP� 1905 Osage St. Ft. Collins, CO 80525 M. EwBnINFA�SG.W'+�9E61C ! E.VO tti ��OCCFJlS�'JSiqn 2:�_ 0��'e 11e ���.��te�����(-� ❑�� X�A.,„,� 9/24/04 IYc � `U��LMOME.NA\_ $IC CEUETEpTORC.9EMAiOAYLOCiiN O'Bri2n-Straatmann-ADfel F_H_ I ��y°^ ❑°a� I 36 E_ Market St_ 4115 Avenue N P.p WMEOIPTECAUSE - P WT ' 1,i�lC�sswe C�Q .� C�'c� P�Pi e 25p DREOFLYV�iV �W.O�yYCf $$c POURQFL4 ��,.�:�. ❑ ��.,� Sc-p< t3 ,2��� i�cv �I Sw_e I� ier�Vq 25p. W,NPYAi Wpr�K ISL v�PCOFCINM.IIM I � � I��`� ` I � �J �"' T M�'id� VM .l0 },a Jn�EOFJFA�r�. Ixb_Oav.viJ 3 s .�c �' 2`y , 2G �`( p$Yi 2]�_�A:ESGVCD l�-��+7Y.YrI Y'c.TWEOC:.U:N 8�a .SC i- Z t Zi�JG�(I �Z,� `{� � a Ir,�.rovexvanr•., e.ce�ac�ec tW"1iCOdMCU[b�.P ,[aufNSlTl'M. / .� IS�.avae w i�el � � �� ❑ �_� N.1uE �W D a00i R.D, fi< � .o ❑ �,w��..� bID , 10 E. 31 C. Bounds 48-2344 �9EGNA.YCY W iXE OpS� a MON�YS� �.��,a.;.� .n n � rx �n n �e I KA. J[�RIBE XOW L'llVPY OCCIIaRF!] {� � 4 � O CCI:.� ; iJ l.lb.Oar vy I �0 FS�neral Home ;= ro-nw s:are ney, IN 47611 werya oewem wua am r<am � i'�u�tcdi�-�e � `.e..v aen.em we� ✓c a� i , , � hYe�vL CCfnttn CnY1 iR' CeaT I 1 1 I2`. W+SUSE�EE3REJiOHEX .� 1 iOW:: $iPi[ Sc o{ �—BJ;,�IE I a�= I I 't' � o I zs >wna:.�c_o ov.c iw.. �.. r<� I z�. asc�a:.vice> o�no n u ��Y I °�[Ci 2El.OnNPJaL5010�YTnlYl�Y2'IXYNlS'{']MINM�'�4a��=urtpCdl 3 PIOt'nP.Ci�PYqyyClyq:X9CMCiu�l�S�Ta'M ,IS¢a]ve us' iYl � OP.T�bSUEDONa,�N_cEN�ON9DcA�i �T LI 1'ES I�I +O ��GFNEYI /ryqro�?..9 Kearney, NE 68847 Ci �_�� ❑..r �G� � � ?�r:�,