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PH3-?98(VS)REV.a-(9 STATE OF NEBRASKA
<br /> FEDERAh SECURITY AGENCY DEPARTMENT OF HEALTH
<br /> PUBLIC HEALTH SERVICE is
<br /> • Bureau of Vital Statistics ' it, - 5 t
<br /> BIRTH No. 126.___-. CERTIFICATE OF DEATH STATE FILE NO.
<br /> '1 1.PLACE-OF DEATH 2.USUAL RESIDENCE(Where deceased lived. If institution:residence
<br /> ..COUNTY Hall . _ ..STATE Nebr. b.COUNTYH ail before admission).
<br /> j ,4 b.CITY(If outMde porporate Rmi4.write Royal)e. LENGTH OF c.CITY(If outside corporate Smite.write RURAL)
<br /> OR
<br /> sT Y plat.) TOWN Grand Island
<br /> x TOWN Grand Island 71. f�'hl�"
<br /> 9 d.F10SPJT 4ME OF(If not iv hospital or ineitution.give et address d.STRRET (tf coral,give location)
<br /> •' M iN iii TION St. Francis iiospitllr«auool ADDRESS 1717 7,est First
<br /> 3.r 8 DECEASED NAME F a.(First) b.(Middle) e.(1.t) 4.DATE (Month) (Day) (Year)
<br /> (Type•.Pr4) Michael Francis Flynn I DLNFTHSept. 3, 1051
<br /> 5.SEX 6.COLOR or RACE ?.MARRIED.NEVER MARRIED 8.DATE OF BIRTH 9.Age(In yr..It Under 1 Yr.If Under 24 Mn.
<br /> WIDOWEIC DI ONCED(Specify) lul day) Mos. Deye Hours Wv.
<br /> `° � tl Male I white I marrlec� i-2d-1090 I � I
<br /> j `2r,_USUAL OCCUPATION(Give kind of work 106.KIND OF' BUSINESS 11.RIHTII-(City,loon or county)TAIL CITIZEN OF WHAT
<br /> t'!f g,v t of working life,noon if retir:) OR I$pZSTRY PLACE toret ) COUNTRY?
<br /> ;$ der forerdan _ I Railroanine I Council Biufis,nntl'a. I U. b.
<br /> • II.FATHERS NAME Oa.MOTHER'S MAIDEN NAME Iak,NAME OF HUSBAND OR WIFE
<br /> r' ,� John F1'-nn I 'z•beth Lear, IM ra Flynn
<br /> 9.8 1 I,.WAS DECEASED EVER IN U.S.ARMED FORCES? 14.SOCIAL SECURITY 17.INFORMANT'S NAME or Signature&AddreM
<br /> s �ITee,no.or unknown)(If yM, vat'to da ,of rrvt )' NO.
<br /> Ye' Sorb nor «I ?Myra 1''1-•1. ,"ra:l.i Isianti0Nehr.
<br /> =E= 1 I6.CAINE OF DEATH - MEDICAL CEI(TI}ICATION Interval Betw«n
<br /> S Enter u,Ir one snots,cr O and Death
<br /> e j-v. hve fur 1.).Ibl.and(e) I.DISEASE OR CONDITION
<br /> line DIRECTLY LEADING TO DEATH° Cerebrcl Va$culaT tacciuerit 9 1-51
<br /> '- 9
<br /> e n,o C`� •This deea not mean the. ANTECEDENT CAUSES .._..._.._.._.._.._.._.....
<br /> �.; oat er a>ing, .a h DUE TO (nl.. Y pert eQS$O.II
<br /> I.1 5 o ,, h`s0 (.Ilorq uO,eNti Morbid dition,if ,teeing
<br /> It mono [be die- rW 4th.eke..<rvM(O. ting
<br /> 'P1'5 se,colors,or edm.i' the vnd<rlymg
<br /> .rhi<h caused death. eao.e Wt.
<br /> 1'r_ I 11 OTHER SISNIFICANT CONDITIONS
<br /> r „Rm� I C ndti tone contributing to the death bat net
<br /> \\ related to tine di.aa.e or condition<anon.death.
<br /> i �pa 19•.ifATE OF-OPERA-'190.MAJOR F'INOINGS`OF OPERATION 20.AUTOPSY! •
<br /> I . c,e E none nUNI - I Yee O No
<br /> t 1,� a -la.:\C.CI?,ENT 15peci(y) Sib.PI.41'E OF'INJC11Y fc.g„Iv r about)21c.(CITY OH TOWN) (COUNTY) (STATE)
<br /> E51 1(1110 Thom.',Ierm,(.000,0,stmt,office bldg..etc.) (11 ru,.)area,wUte RURAL)
<br /> 3 7 HOMICIDE
<br /> • E :Id. OFL (MOOth) (Day) (Ye.r) (ioum)I 21e.INJURY OCCURRED 101.110W DID INJURY OCCUR?
<br /> While at Work
<br /> o o INJURY Not W6ilc at Work D
<br /> I It 0 6 22.1 hereby eeriify(Jett I attended the dettased froriolh-9 ' 195-/,to , eF_' 3',19:5/,that I last saw the de-
<br /> E c as II rtio9 o A,19.?.I.,and that death occurred at 2:25,4 uses
<br /> m the ca and on the daft' s.
<br /> stated abut
<br /> i 2l SIGNATUAL (Degree or[Kiel 21b.ADDRESS 21r.DA E SI EU
<br /> o , � _�� `- - k. L. I Grano Island, Nebraska town.or f /
<br /> AIx tab.1.t'1'E Or.NAME OF CEMLTEItY Olt(IIESIATORY 144.LOCATION(City,4 (State)
<br /> ✓ III°F d o5 YAL S f lb .-J� I t
<br /> E 1 k1 _ `t JOSEI.l , _Lexiet.Fry I CRS::CNA Bluifs, Ia
<br /> 1..1 HI:.00. A,``TitAR 6 214 TORE � / 3+,FDIERAL U E_u c.'S$IGNATLRL ADDRESS
<br /> • z --- °�' ii•4C I+r_-:1.45 toe-a Vll e^.,:.: , a.: _slar:'i,
<br /> -=-riae-= --- e"r
<br /> • `
<br /> .TIC GEl2TiF E'A$OVE TO BE A TRUE COPY OF AN ORIGINAL
<br /> ', C,,R I,LE WITH THE STATE DEPARTMENT OF HEALTH,
<br /> t. i>T•OF'' A� STATISTICS, WHICH IS THE LEGAL DEPOSITORY
<br /> • DIRECTOR VITAL ST 1ST AND ASSISTANT STATE REGISTRAR
<br /> LINCOLN, NEBRASKA
<br /> 1 I- ...e -
<br /> T% O:1,11-..-:-'4 A?K>_A• t ea.
<br /> I hereby certiY. that this bastfl1 avSs
<br /> entered on Numerical i<: c and tiled `..r
<br /> tord this 9
<br /> t-
<br /> d,ity cf January ,, 54 at 10:20
<br /> o cleak A 3s, nisi." d Jai book
<br /> No 1 of Miscel. la
<br /> Regief.m of Deeds
<br /> 2.25
<br /> Depaty
<br /> F L. 2.25
<br /> r .
<br /> A.
<br />
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