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<br /> t I i C A T I O)AND wHf7AEi D I F F A X T M I N T�yOF�AISIE 1
<br /> iteTH xo. 12t_.__. C LR77Pl '1'lA'U '1'H 1
<br /> STATE ME MO. .
<br /> l47 .lrATE Nebraska ►ooUNTY 9a* _.rw.R).:J
<br /> yp L i N O T H Olt.e.CIT'T(If 0.1414.we1.e.M EMI.wit*RURAL) - 1
<br /> l +rAY Town Grand Island
<br /> d .' .. I d.ADDRESS (H ewe!,.1w klrtiw) 1
<br /> E L NwMi OF ADDREp 822 eat 7th. jj
<br /> DECEASED
<br /> OF ••(NU/ ('ir',) L 1 C DATE (M..ta) ( -..i
<br /> ik. / or
<br /> Print on Yickerill v2AFTEFeb• 16 1968
<br /> ( r,MARRIED.NEV74t YAEIUID. iip`]y.-'e'r�,Rry:.yjR�7�6w.�sSe
<br /> WIDOWED,DI orn (ee.dry) l)—
<br /> Ina.USUAL OCCUPATION(Olw kind ai n..k 1N.RIND or BUSINESS II.BIItRATH•(City to..w waits)S&M. -,
<br /> s..tat.orb..8h. N Mind) R INDUSTRY �ItAOR tapir w..tr, T
<br /> \�� HuilBon halt Zle r. (iP:"'$. ! I
<br /> IY.MOTHER'S MAIDEN NAME
<br /> C-en A. 44 ', '1
<br /> 14,WAS DECEASED EVER IN U.R ARMED FORCES? ;' ;eM Ir.INFORMANT'S NAME or Si...tn.•AMeer
<br /> ii S t (Y....a.....k.e..lY....Fin......a.tr«..rr1..)
<br /> IL CAUSE or.DEATH Francis Y. Yickerill
<br /> �'! IL C 1.b oO°DE Fr L DISEASE OR CONDITION i1rLICAL CL'aTTF1CATlON 0011 itt.... i
<br /> `h I 81.Yx(.).(M...d(e) DIRECTLY LEADING TO DEATH+
<br /> gSAQ � p �/ Ort rd irH �
<br /> ,..-ti%, +111.d.1...t own the ANTECEDENT CAUSES w (.) d'.1Ld!.!j 2L----'-'-
<br /> SSs .�.1 aw ielmd: _ DvE To tM_........_ 111!G..1.{d1,..C..A[__..__ I ::I
<br /> ;ti c,............= as Iii..�•r•ere....L.W W 4rV Mt (.>._.... _. .---__ .. ... .._.. ........_. .:0
<br /> Ss i
<br /> S 13 ;
<br /> .i IL OTHER SIGNIFICANT CONDITIONS
<br /> 11-1 d1....w.1.4140. Ltd d°tb. a.,--4
<br /> E it.. ATE Or OPERA-I 1.b.MAJOR FINDINGS OF OPERATION ,y
<br /> SC AUTOPSY/ ��_7_:•
<br /> Y..0 N. I .t
<br /> III.ACCIDENT (Spei/Y) 1 Ilk.PLACE OF INJU$Y N.L.le .5.11 Ii..(CITY OR TOWN ?{
<br /> .1 SUICIDE bum.,t.rm,hot.-,..tnet,At N. i ICOUNTY) (STATE) ;*cwt%
<br /> HOMICIDE bMF•..t..) IIt nnl.r1.,.N4$IlRAL) 2.,,t
<br /> !Id TINE Month) (D1.) (Year) (H..,) YI..INJU$Y OCCURRED 1 :� 1.L
<br /> INJURY I 40611.Il Wrk O 121f.HOW DID INJURY OCCUR?
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<br /> Y J Nat WW1..t Work fY
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<br /> 21.I hereby osrfifY that I t the deceased -- :r4 zi
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<br /> ie .. /t endue from tsS.-11,to....2-../ .Js..d.0.ttht t last*me the 4)e- I w
<br /> i ceased alive ow 4.-24.,Is...s.k and that death occurs•at•,a''.lfm�from the suttees eRd ow the date stated above. ,`
<br /> {y) Rib.AD Yt..DATE GNID F )
<br /> Fyn�l �j � /� 6i C�.�
<br /> s � YY.aU AE[ L-�t` t.:w r]-.�-:-�/iI�tt I ^ ^.�-� �,��e�tiX G/SI ' 1 k+T
<br /> J i lk.NAME OF CEMETERY OR CREMATORY 124d,LOCATION (CRS.i,K...t) (.01.) ! )�ss
<br /> C$MATIC B
<br /> 'I REYOVA {'9aae1_rll :,-) SJ eae Iowa C'
<br /> OATS Mil SIAM/Cr �WOCa Iowa
<br /> RE/ I+ P EML DI 88 SI NA U i J
<br /> ; ; ''• � .;/ �t Lei wfaQetonenderaitn,Gran2M'slands {
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<br /> THIS C0.41 $It,S1 E A13,6 'kip HE A TRUE COPY OF AN ORIGINAL A
<br /> CERTIFIIS'#. k ' 'IL- r.Till:STATE DEPARTMENT OF HEALTH, ??')''
<br /> BUREAU Q ^'t
<br /> T KS, WHICH IS THE LEGAL DEPOSITORY t
<br /> FOR VITAL. Etp 8. ■u Y-
<br /> C ,. ,
<br /> DIRECTOR OF V TA( !!! S AND ASS'STANT STATE RE.;:-.7.,,:-.?
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<br /> LINCOLN, NEERASK:. Iss(1ed March IO, 1954 .,
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<br /> cord in office :: ,aier o
<br /> the 5- --`-- _I'v of
<br /> April -- iJ34 a.
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