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<br /> srs�,R c�r�s n�ee�ow ro eE�r�co�►oF n�a�av������a�rk�� . .
<br /> THE NEBRA3KA HEALTH AND HUMAN SERV/CES SY3TEA�,V/TAL STAT���,_�}/�
<br /> THE LEOAL DEPOS/TORY FOR V/TAL I�ECO/tD�, ,,` - - �
<br /> DATE OF/S3UANCE �$�. _ :� �� ,
<br /> JAN 2 21998 1��4639 -�- A���o�R:
<br /> ass�r��ir sr�rE a�o�srr�
<br /> unca.n��er=asKa .r�a�n�a�►c�i:�s srsree�
<br /> 4 STATB OF NBBRASKA-DgpAR'IMgNT OF HBALTH AND HUMMI 3Sl�YEBS.gIN�'CS AND 3IIPPORT O �
<br /> VTI'AL STATIS77CS �'> � ;�' �7s `J �,
<br /> CERTTFICATE OF DEATH ,' � �
<br /> �.oECme�T•wwE cxret Mwo� usr !.fOf �.OATE OF OEAiII /M�inh.D��Y�w/
<br /> Walter D. Webster Male Januar 9 1998
<br /> 4.CITY ANO STA OF lIRTH-M net h U.d.A.,nrn�swnary/ W.AOE•lrt lMtAd�11 R 1 1 e.DAiF OF lIIITH /MonM.D�Y.Yrrl
<br /> (Yh.) 6A.M08. DAYB 60.NOURS MNB.
<br /> Gibbon Nebraska 88 ' ' Se tember 2 1909
<br /> �.soau eccuroTV�een M.PIACE OF DEATH
<br /> • 508-16-1286 . � ��. � a,�.�,�
<br /> B0.FAqU7r'N�nr M ne/h+M�da'.'Plw tb�r�nd iwn�A�r/ �ER OutpnWit O 1Wd�nw �
<br /> • St. Francis Medical Center ❑�„ ❑o�,�,�,,,r�
<br /> eo.an.rowN on wrwraN oc oEwn� ea.ws�o¢aTr uMrca s..oou►rr oF oEwn�
<br /> Grand Island �p � � ❑ Hall
<br /> W.RE9IOBiCE•STA7E Po.COUNi1 Ye.qTY.TOWN OR IOGTION Po.87pEET pND NUMBER /hd�ai�y y�o Cedy y�.NgIDf CITY UMITS
<br /> Nebraska Hall Wood River 1110 Mazshal168883 Y„� ,� ❑
<br /> 10.MCE-M.y..WNt�,lt�tk,AmMlun Ndr�. 11.ANCESTRYH.o.Mia Muie�Or�n�ta.l � 12. MARPoEO YWDO WED 13.NAME OF BPOUSE /M wMt PA'�m�Mn iwr�l
<br /> �te.l ISp�dryl �N
<br /> W"1 En li h NE�p a DIVORCED
<br /> t4.USUAI OCCUPATION-/C/v�Ar�p e/wpk Rpr�ylwip mqt��^ 74p,KND OF lUSNE39 WpUg7pY � 16.EDUCATION FY q1�Y NIOHEBT URApE COMKE7ED
<br /> or wa.ftr�y a...wo a i«r.a� 1� 1 ar�.M.n«9.�ondrr(a�r ca.a.��J d s.�
<br /> , Fazm r A riculture �
<br /> 1E.FATHEN•NAME FIPST MIDOLF U9T 17.MOTHEM FIR3T M�pp�F
<br /> MA�UEN SUqNqME
<br /> � Carl Webster Hattie Roach
<br /> 18.WAS DECEASED EVEfl M U.S.ARMED FONCES7 1 W.NIFOINMNT-NAME
<br /> rv...no«o,it.) 1M n...oh»w..�a aw«a.«vkw .
<br /> John Webster
<br /> 19b.MIFOINAANT MAllIN6 ADORE93 (STREET OR R.F.D.NO.,GTV OR TO WN,BTATE,21%
<br /> 1408 West St. Wood River NE. 68883
<br /> �O.EMBALMER•SIUNATUpE a LlCprgE NO. 21�.METH00 OF DISPOSIT1pN 21b.DATE
<br /> Yta.CEMETERY OR CREMqTORY-NAMf
<br /> ���
<br /> Zz,.F �, E-�, �,,.,,, ❑�.,,,.A, .._O 1 l 12/1998 W ood River Cemeter
<br /> � 41d.CF7METERY OR CREAMTORV LOGTION GTV OR TON?I STAiE
<br /> A fel Funeral Home ❑Q-�����«� Wood River Nebraska
<br /> 2�b.FUNEML FIOME AOOREg3 �gTpEET OR R.F.D.NO.,pTr OR TOWN,STAiE,ZIR
<br /> Wood River NE. 68883-126
<br /> 23. IMMEDUITE GUSE (ENTER ONLY ONE CAUSE PEp l.M1E FOR W.(�1.ANO(c�l
<br /> PART Acute CVA I '^�«�r e.cw«�w..�.,m a.an
<br /> � � Minutes
<br /> � DUE TO OR AS A CONSEQUENCE OF
<br /> Chronic cerebrovascular insufficiency i '"�«��D��'�^�•�d..��
<br /> WE TO ON AS A OONSEpUENCE OF
<br /> � Years
<br /> Generalized arteriosclerosis � . � �^�M��"^���M"`.rod�`�
<br /> � Years
<br /> OiHEN SIGNIFICANT CONDITIONS-CenA�leti aoiwlwy�p�o�M d�t�p����b pART III IF FEMq�E Yypg iMENE A 24.AUTOPSY 26.WAS CASE REFERRED 10 MEDICAL
<br /> tART Severe COPD/ASCVD
<br /> PNEGNANCYMJ THE PAST 3 MONTIIS) EXAMINER OH CORONER7
<br /> 2G. IAUw 10�5�1 Ve No Yw No Ym No
<br /> 26b.DATF OF INJURY /Ab,p��y,� y�,HOUR Oi WJURY 78d.DESCIqBE HO W MIJUHY OCCUflNED
<br /> ❑AarJAww ❑UMn�rminW -
<br /> ❑� ❑hMnp 2M.MIJURY AT WORK 2E1.%ACE OF WJUpY-M Awm,Irm,mwt,Netory ydq,�pCpT�p�.� gTNEET OR p,f.D.NO. CITV OR TOWN STATE
<br /> � olflca EuNdnO.�ta.•ISD�d�Y/
<br /> H°^�b' Nmnq��lon Y�t No�
<br /> 2Ia.DATE Of OEATH /Ma,O�y,ri.� 28�.DATE SICNED/MO,D�y,Yr./ 2BE.TIME OF OEATH
<br /> r� Januaz 9 1998 A
<br /> 1'fr�t�
<br /> �� 21D.DATE SICNED/Mo,WY.Yi.! Y7c.TIME OF DEATH �j`` M
<br /> �r '_��_98 ��i„ 29c.PNONOUNCED OEAD/Mo,D�y,yr./ 4Bd,PpONOUNCFU DEAD lNour/
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<br /> 27d. io tM bs,t ol krowlW t tkro. ets�nd q�cs�rd du�to M �"�
<br /> u�++�l�),bted: d �8�. On[M bul�ol��emjrrtlon�nd/a InvMlp�tlon.In myoplNon dutA occunatl et
<br /> ISip�un�nA iitlal► tM tims.dets�M p1sc��M dus to tM uuNl�)�tetad.
<br /> Z9.OID TOBACCO USE CpNTRIB EpTF{� (�O��a a^d nh�) �
<br /> j 30a.HAS ONGAN OR TISSUE NATION BEEN CONSIDEREOT 30b.WAS CONSENi GRANTE01
<br /> � � YES ❑ NO .a UNKNOWN
<br /> YES � NO � VES (�
<br /> ��� I .1 NO
<br /> 3 t.NAME AND ADOHESS OF CENTIFIfR�PHYSICUIN,COppNEfl'S RIYSICUIN Oq CpUNry ATTOINEY) /7 �-��
<br /> YPQ w RN1/
<br /> Steven L. Hus M.D. 2 1 W. Faidle Av 4�400 Grand Island Nebraska 68803
<br /> �2a.REGISTRAp
<br /> ' 32b.DATE fILED BV qE I TRAq /Mo Ds
<br /> ------- • JA� 2 0 �1���
<br /> Lot One (1) , Block D, in First Addition to Wood River Village, Hall
<br /> County, Nebraska
<br />
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