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<br /> O (42) OF CHARLES WASMER' S SECOND ADDITION TO THE CITY OF GRAND
<br /> ISLAND, N�BRASKA, SUBJECT TO ANY EASEMENTS AND RESTRICTIVE
<br /> COVENANTS . ��-�-r�
<br /> Rev.t t�97 STA1E OF NEBRA$KA-DEpAR'Ib�Nf OF HBALTH APlp
<br /> HIIMAN SERVICfiS FINANCE AND SUPPORT
<br /> VCfAL STATLSTICS
<br /> CERTIFICATE OF DEATH `��"''_��_F^��S4
<br /> t.DECEDENT-NAME FIqST MIODIE UST 2.SE% 3.DATE OF DEATFI �MOnrn pav Vean
<br /> Phyllis Jean Wright Female January 15, 1998
<br /> a.CI7V AND STATE OF BIRTM ill�fin U.S.A..nems coun(ryl Sa.AGE-latt BirtlWay UNDER 7 VEAq UNOER t DAV 8.DATE OF B�R7M iMOnm Dav.rean
<br /> SIDUX C�ty,Iowa (�rs� 7C Sb.MOS. DAVS Sc.HOURS MINS.
<br /> � � September 02, 1921
<br /> 7.SOCIAL SECURTIV NUMBER Ba.PL4CE OF DEATM
<br /> 482-20-6922
<br /> � MOSPITAL � Inpanem OTHER: ❑ Nursmq Hor++e
<br /> 8p.FACIUTY•Name /Unot msMUfron,grve s�ive�airo'numpei/ � ER OutDaUent � qesitle�ce
<br /> St. Francis Medical Center
<br /> � � �A � Othe�iSaearo�
<br /> Be.CITV.70WN OF LOCATiON OF DEATH Btl.INSIOE CITY LIMITS Be.COUNTV OF DEATH
<br /> Grand Island Hall
<br /> Ve� � No �
<br /> 9a.RESIDENCE-STATE 9b.COVNTY 9c.CITV,TOWN Oq LOCATION 94.STREET AND NUMBER /incivamgZp Cooei 9e iNSiOE Clri UMi-S
<br /> Nebraska Hall Grand Island 1603 W.John,68801
<br /> Yes � ,vo �
<br /> t0. AnCE-�s.g.,W�ita.Biack.amencan Intlian. t�.ANCESTRV ie.q.,itaiian.Meaican.German,eicl t2.a MAFlRIED �WIDOWED 13 NAME OF SPOUSE �n w�le
<br /> .grve ma�den came!
<br /> � �"' r�4tf'�4�ican
<br /> C NEVER OIVORCED Paul A. Wright-dec'd.
<br /> � � 14a. USUAIOCCUPATION /GrveMnCOlworkOprredun MAA �
<br /> H >q masi t aD.KINO OF BUSINESS INDUSTRY 15.EDUCATION S c Iv omy niqnest graae compie�eel
<br /> N o i� i.en.au� i ae�
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<br /> C i6.FA7HER•NAME FIRST MIDOLE LAST V.MOTMEF FIRST
<br /> MIDDLE MAIDEN$URNAME
<br /> a+ � : Leslie Quintard Ethel
<br /> Albert
<br /> � � 18.wAS OECEASED EVER iN U.S.ARMED FOqCES? 19a INFORMANT-NAME
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<br /> C 1� Paula Crandell
<br /> � � 19C.INFOqMANT MAILING AODRESS �STREET OR R.F.D.NO..CITY OF TOWN.STATE.ZIP)
<br /> � 140 16th Street SE, LeMars,Iowa 51031
<br /> �
<br /> V 20.EMB -�IGN Ed I SE O. 21a.METNOpOFDISPOSIT10N 21b.DA7E 21t.CEMETERVORCaEMATOav NAME
<br /> F- �
<br /> Z E " �`i' 'z �]e���� �qemova� O1/19/1998 Westlawn Memorial Park Cemetery
<br /> W 22a.FUN RA�HOM -NAME
<br /> � � 21tl.CEMETERV OR CREMA70f7v LOCATION GTV Cp 70WN gTa-=
<br /> w Apfel-B er-Geddes Funeral Home Grand Island, 1�lebraska
<br /> O .v �Cremauon �Donairon
<br /> QL 22D. FUNEFA�MOME ADDF7ES5 �STREET OF R.F.D.NO..GTY OR TOWN.STA7E,ZIP�
<br /> � a 1123 West Second Grand Island, Nebraska, 68801-5899
<br /> O � 23 IMMEDIATE CAUSE
<br /> Wc � PAFT IENiEF ONIY ONE CAUSE PER UNE FOA iaL Ibl.ANO�cll � �niervai benvee�o�se�anc-ea���
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<br /> OTHER SIGNIFICANT CONOITIONS-COnCinOns contnbuong to Ihe tleaM bul not relaleA PART III If FEMALE.WAS 7HERE A 2a q�TOPSY
<br /> PART 25 WAS r.�SE aEPEAaEn'i"nECiCa�
<br /> II / ,^ f_G`�� PREGNANCY IN THE PAST 3 MONTHS° EXAMw"cA OR CO�ONE�"
<br /> v �"�1 �7
<br /> IAges�0-541 Ves No ' Yes No � ves r I No ���
<br /> 26a. 26b.OAiE OF INJURY /Mp..Oay Yc) 26c.HOUR OF INJURV 2EC.DESCRIBE HOW�NJ�RV OCCOaRED
<br /> � Acntlent � UnOetermmetl
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<br /> Su�CiOe � Pentlmg 26e.INJURV AT WORN 26t?LACE OF IN,IURY-pt home,larm.5treet laelory 2 .LOCATION
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<br /> Homiad� invesagauon y�
<br /> 27a.OATE OF DEATM /MO..Day.Yr/ 28a.DATE SIGNED (MO..Oay.Yil 28b 71ME OF DEATH
<br /> S�4 ����' / v a��
<br /> �� 27b.DATE SIGNED /MO..Oay.vr.� 27c.TIME OF OEATM �"�
<br /> 30 �s�
<br /> 2&.PRONOUNCED DEAD /MO..Day,Ycl 280.pqONOUNCED DEAO /HOUn
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<br /> 27G.70 the bast ol m knowlaC s.d�aN ��az 8 M
<br /> Y 9 �M aa�a ara p�ace ara due a ,.�c� 28s.On me b�us of eaaminaaon anC�a mvesugauon,�n my opnion deatn occuvee at
<br /> eawe�st suted. ✓ a tha nme.Can ana paee ana aue to ms eause�sl su�ea
<br /> 1 �nature antl Title ► i�L-� 5 naNro antl Ti11s
<br /> 29.�ID TOBACCO USE CONTRIBUTE TO THE DEATH9 3p.a HAS OPGAN OR TS❑$UE OONATION BEEN NOO DERED7 30.b WAS CONSENOR yES D' �NO
<br /> � YES � NO ❑ UNKNOWN
<br /> 31.NAME AND AODRESS OF CEPTFlEA�PMy$�CIAN,COqpNER'S PNVSIC{AN OF COUNTV qTTpqNEY� /Typs y piinry
<br /> Dr.Steven L.Husen,2116 W. Faidley Ave.Ste.#40,Grand Island,Nebraska 68803
<br /> 32a.REGISTMq
<br /> . 32b.DATE FILED BV REGISTRAR (MO.,Day.Yc/
<br /> FOR VITAL STATISTICS USE ONLY
<br /> Place.......................A................................B................................C................................D................................E................................Part II......................TMV...........................
<br /> NSC.............................................................................. '................................................................................................Census Tract No.
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