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PHS­79S VS) REV. 1s3 STATE OF NEBRASKA <br />DP.PARTMENT OF PUBLIC HEALTH, <br />DEPARTMENT OF HEALTH <br />EDUCATION AND WELFARE no— Of vital Stituittla. <br />BIRTH NO 126...... CERTIFICATE OF DEATH STATE FILM NO.__.__.... <br />l PLACE OF DEATH M 2, AL <br />I'll <br />COUNTY Mall STATE N-0bra"Ll __HAlr_ <br />b. CITY Of B."") I, LENGTH .1 1. CITY (If RURAL) <br />TOU, Grand, Island STAY OR <br />TolmH Grand Island <br />d. FULL NAME OF Ili - in 1-01.1 or 0- lt,o,ot d. STRErr (if ­J ifl� L-0m) <br />'DRESS 1 <br />�TC SPITAL OR Ar 0 W <br />ISTITMON Fourth <br />1 3. NAME OF 'MI.) b. I i4dk) "4. DATE <br />P (Umt►) (D") (y�) <br />:3 P,W) Fred Ro esch Jeb._.25,1_qi� <br />1, SEX 6. COLOR I RACE MARRIF11. NEVER MARWED, S. DATE OF BIRTH 9.AGE (I, m.: If Uo&, I V, it Uoio, 24 H- <br />� ' <br />WIDOWED, DIVORCED is <br />ify) - birtWl l, moo, 1b, . Ift,,. <br />M , ale white . widowed- - ­ 91, L� <br />l ( W,11, OCCUPATION (Gl- ki� of ­k lob. KIND OF BUSINESS I]. BIRTH (CIV. - -.0) Is.. ZEN F <br />d f ­ki.. fife, .- 11 OR INDUSTRY PLACE .1 1.-- 12- STEP <br />ietired Rallroadeiz RAilroAdimg _ Bxvari Gj�;. _u. a— .- _ <br />A (nF <br />THER'S NAME MOTHERS MAIDEN NAME N USAN,� OR WITZ, <br />No Fecord No Record Wilhelmine F lkenbe�Kj.. <br />vim lu� NAME 114-- & Add- <br />lsy.71 DEC-SED EVER IN U. S. ARMED FORCES.' SOCIAL It. SIR, ti. IHI�oj bj�S <br />no W..,L. RopachifUrand Island,!! <br />I6. CAUSE OF DEATH MEDICAL CxRTqqCATION <br />sorer I. L DISEASE OR CONDITION It- 1 1. . DIRVTLY LZAI,ING TO DEATH- <br />ANTECEDENT CAUSPS <br />DUE TO (b) <br />beam (tlleu, <br />Im dM­ 00 _u,,g <br />I.J." DUR TO 1.) <br />IL OTHER SIGNIFICANT C9N14MONS <br />Coedlr <br />191. DATE OF OPERA l9b. MAJOR ►INDINGS OF OPERATION <br />TTON <br />Y <br />2- AC( -IDRNT (Spoifv) ?l1b, PLACE OF INJURY 1,, .boat' 2W. lCm TOWN) (COUINTY) <br />IRATE) <br />SUICIDE `-o. I— I­ wroet. off- MAI_ (If ­t. RURAL) <br />HOMICIDE <br />W _v WAIOW MD lid. TIME 111-h) (Doo I-_- ti.; INJURY bm-UR196 <br />or iriib . W-k <br />INJURY Ii Noe Whil, 't W <br />n. R9 <br />I hereby certify that �-ttclsdp�lhd d. 16- that !.loll am the do- <br />t ,NAME �!� <br />dimak fice-rod Irooto the <br />Ilk- DA <br />j -2 71 <br />CRIDIATION 0 2-26-57 Grand Island Grand Island, Nebraska <br />OfIFAL -If,, <br />li� _ [I'Sk <br />DATE RECD By 1,Ot AL. MA <br />V qs <br />man - I lorl'?, . M04405ruManEfiraft I milan <br />Issued March 5. 1957 <br />