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1 DECEDENT - NAME FIRST MIDDLE LAST
<br />Marvin Lee Morrci
<br />2 SEX
<br />Male
<br />UNDER 1 DAY
<br />3. DATE OF DEATH (Month Day Vear)
<br />July 7 1998
<br />6. DATE OF BIL H ( Day. Year)
<br />4 CITY AND STATE OF BIRTH /enol in USA.. name country)
<br />5a. AGE - Last Birthday
<br />Yrs1 69
<br />UNDER 1 YEAR
<br />Horace, Nebraska.
<br />Sb MOS i DAYS
<br />Sc. HOURS MINS
<br />D e m b e r 1 1 , 1928
<br />IJGL
<br />7 SOCIAL SECURTIY NUMBER
<br />508 -28 -9499
<br />8a. PLACE OF DEATH
<br />HOSPITAL ❑ Inpatient OTHER ❑ Nursing Home
<br />❑ ER Outpatient ® Residence
<br />( ._ ❑ DOA ❑ Ot °yI
<br />8b. FACILITY I 1 T" .•-• flfeot mstituao,o give street and nurnberl
<br />Ic
<br />608 _ =c ;1..1c, y •
<br />-_
<br />Be CITY TOWN e - •CATION OF DEA H I- ST "T - -- - - ',__'_._
<br />Grand Island
<br />- :.95NtDE CITyAg
<br />Yes Ell No
<br />8e COUNTY OF DEATH
<br />Hall
<br />9a. RESIDENCE - STATE
<br />IM I ' 1ICN C DEb
<br />Nebras - Wit_.__
<br />9b. COUNTY
<br />Hall
<br />9c. CITY. TOWN OR LOCATION
<br />Grand Isl
<br />F r4 4 a14 p ��5 r 5 mY k wleQge.d•attrep -- at-the fine, date and-place, and due to me
<br />dauselsl stat l 7 , _ <a
<br />i
<br />Signature and Tit ► �,, �.--
<br />90. STREET AND NUMBER (Including Ztp Code)
<br />608 N. Grace Ave, 6 8803
<br />9e INSIDE CITY LIMITS
<br />Yes No 11
<br />Q
<br />10. RACE - Whi 4 , '
<br />(eg,
<br />etc , ,Soap yl
<br />trite
<br />11. ANCESTRY leg- Italian.Mewcan..Ger,�n ++ T
<br />e dli -,,
<br />lSpeciyl
<br />American
<br />t g. t , . W MARRIE.O, (1 WIDOWED
<br />L -_ LL
<br />NEVER 11 DIVORCED
<br />❑ MARRIED
<br />13. NAME OF SPOUSE la wile. gave eraden name)
<br />_
<br />Maxci ne M. Schl a i ch
<br />14a. USUAL OCCUPATION (Give kind of work done during most (1
<br />of working tile. even if retired, T yt'T
<br />construction k wor r
<br />14b . KIND OF BUSINESS INDUSTRY
<br />fb Trnnwnres
<br />CI
<br />LDl/
<br />Firm
<br />15. EDUCATION (Spec only highest grade completed,
<br />y
<br />Elementary or Secondary 10 -12) College I1 -4a 5.1
<br />8fh Grade
<br />16. FATHER- _NAME - FIRST .__..._.._.- . _M,IDDLE - _- r . L AT_ __ _S,17
<br />Curt Mcorrr wL 4
<br />MQTHER___ FIRST MIDDLE MAIDEN SURNAME
<br />-
<br />k � w n
<br />(r)P(ii=!( ) Mary r thQl ''" C'1 pmt t.
<br />1 8. VJAS- r�'')�
<br />(Yes n I y^
<br />L-- Ye I
<br />Elf ARMED FARCES �,
<br />p{ 4s - d rte - K rZan 7 '
<br />arOMd _a sb a wS
<br />02/01/1953 O4/08/1955
<br />-J9"1 INF7'f?MANT NAM 7 ,• /T -Y'
<br />, 1 1 ,' �` T - 1 '3J C. T)f1 _ ' T y, Z L:': .13
<br />Maxcine Mor 7
<br />OTHER SIGNIFICANT CONDITIONS - Conditions contributing to the death but not related
<br />PART
<br />II
<br />4-i /
<br />PART 111 to FEMALE. WAS THERE A
<br />PREGNANCY IN THE PAST 3 MONTHS'
<br />(Ages 10 -541 Yes n No n
<br />24. AUTOPSY
<br />Yes ❑ No
<br />WAS CASE REFERRED TO !.'-D'.,J' L
<br />EXAMINER OR CORONER' /
<br />Y I - I y
<br />Yes ❑ No
<br />26a.
<br />•
<br />0 Accident . Undetermined
<br />® Suicide 'a Pe0 tng
<br />. Homicide Ineestgatron
<br />26b. DATE OF INJURY /Mo Day Yr.)
<br />26c. HOUR OF INJURY
<br />M
<br />26d. DESCRIBE HOW INJURY OCCURRED
<br />26e. INJURY AT WORK
<br />Yes ❑ j(4o ❑
<br />26f. PLACE utld eURtc. (S OF_ INJY - At home ,01 ,13 street factory
<br />o Ice D peci y
<br />y
<br />. NO. CITY 0R TOWN STATE
<br />26g. LOCATION STREET OR R FD. -
<br />- -
<br />ItVVAlt...ot DEATH { ( ` M T o ( . Day Y4 -- - _. r. ' _ " " -"
<br />' 4 3 tJ( ` oa.. V r ~.0 r'"'c� a- T 11.1 -,_ Er '{l '(, -
<br />I j 0
<br />28a. DATE SIGNED (MO. Day Vrl
<br />{ �;1 1 ,.
<br />2 8b TIME OF DEAT
<br />M
<br />= 2i> U7E- 3'16 '(MO -: Day. Yc) . -- -
<br />270. - :TiUE''I H' '!` 3' _
<br />28c. PRONOUNCED DEAD (MO.. Day, Yc)
<br />280. PRONOUNCED DEAD (Howl
<br />F r4 4 a14 p ��5 r 5 mY k wleQge.d•attrep -- at-the fine, date and-place, and due to me
<br />dauselsl stat l 7 , _ <a
<br />i
<br />Signature and Tit ► �,, �.--
<br />28e. On the bass in
<br />of eoamation and�or investigation n my opinioNBeath occurred ud al
<br />the tune, date and place and due 10110 cause ? s stated • ` 3 - 4 I q1 L 10,
<br />IS nature and Tide( 7
<br />29 DIG- IIlA'CCOLU4EA• TRi 7 ' 0 THE DEAT n
<br />• Omfr l.. - ❑! NO �L'f4 ai UNKNOWN
<br />• 30.a HiS ORGANOR TISSUE DONATION BEENCONSIDERED
<br />t(a ..i. ❑''YES ' V� NO
<br />30.b WAS CONSENT GRANTED, T^
<br />❑ YES NO
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN-SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECQR. - ON ME TH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SSCTION WHICH'IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS r
<br />DATE OF ISSUANCE
<br />2013001
<br />easoPER '-
<br />ASSISTANT STATEREGIS'TRAR
<br />LINCOLN, NEBRASKA
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH HUMAN SERVICE FD ANCEA S it 'IpRT
<br />VTTAL STATISTICS . _- -- _
<br />JUL 281998
<br />CERTIFICATE OF DEATH
<br />19b. INFO. AI(IT .. u -E.c _ MAILING AD SS '._ __. °_ (SIRE ET :OR R F_RNcL. ITY OR T ,STATE ZIP(
<br />608 N Grace Ave..; Brand Island, Nebraska 68803
<br />20 E
<br />B, . 1GtskIUt1E tic E NO: Q ��� 21. )METHOD' OE DISPOSITION
<br />1' t
<br />IFleifre rtiirieral Home
<br />22b FUNE1L 1)C ESS (STREET OR R.F-D- NO cite Qhat IN_- STATE. ZIP) . _ _ ..
<br />DUE TO. OR AS A CONSEQUENCE
<br />lc)
<br />1:)I a tnccroj ; K i%
<br />_ ( n v , ,•., U'ruc „0x1
<br />Cremation
<br />3213 W. Nortrr -Fro rt St. , Grand Island, Nebraska 68803
<br />23. IIaMEDOZTE".CAUSE
<br />PART
<br />(al
<br />DUE TO, OR AS A CONSEQUENCE OF � e
<br />M g 1. R - 4\'
<br />31 NA AND:ADf1 FSS OfCEf,{,i1F Y$I j ) N R S P}A'';I(,IA OR CC�t ftITY ATT0 I frype or Pohl( _ _
<br />r -r burial ❑ R enoval
<br />=210. CEMETERYOR CREMATORY LOCATION CITY 614 TOWN - '. ' - • STATE
<br />(ENTER ONLY "ONE CAUSE PER LINE FOR la). 5). AND Icy.
<br />•
<br />If khan' FI. ' Bader t i) � 2,_• 1 Broadwell Grand Island NE 68803
<br />I 3211. DATE FILED BY REGI$Tj�R 2911898
<br />OE
<br />HEALTH AND HUMAN = SERVICES SYSTEM
<br />r:.
<br />21c' CEMETERY OR-CREMATORY NAME
<br />Do a' Grand Island, Nebraska
<br />Grand Island City Cemetery
<br />IE
<br />Interval between onset and deal
<br />Interval between onset and deal
<br />Interval between onset and death
<br />
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