Laserfiche WebLink
WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF- HEALTH AND <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE Q IGINAI.,f2E'CORd bN <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, .VITAL RECORDS; <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. i / ` • <br />DATE OF ISSUANCE <br />MAY 0 9 2913 <br />LINCOLN, NEBRASKA <br />STATE OF NEBRASKA <br />201304119 <br />A. <br />ET NLEY SCOOP <br />ASSISTANT SLAT REGISTRAR <br />. DEPART,MENT OF HEALTH AND <br />HUMAN °.5RVICES', . <br />STATE OP ? AEILD OAr__ALB_,411HR MAN <br />c T 1 11 <br />RS VV9 14 oA CO UNTY ATTORNEY] i Tyyeo, Prater - <br />Paul C. Wibbels, M.D. 115 N K Ave. Hastings, NE 68901 <br />32a. REGISTRAR <br />32a 04.7E FaM3 BY REGISTRAR AW_ QM 1`1 <br />OCT 17 ,2002 <br />Y umadaw -MULE- pear -- MADtl1E <br />Kenn h <br />I <br />a AMR <br />r 1 _ <br />TE OF MIRTH Ws.*1MA.. NMat eYi <br />harm, Nebraska <br />Sa -Wt <br />Iw.I 85 <br />Ana. 21. i <br />DAYS <br />ten*" MPS <br />7. a <br />SQ -18 -6379 <br />PLACE � <br />� OtINTAL 1 maim pewee ❑ thane Mow <br />❑ ER ONXINI ❑ I_ __ - <br />❑ DoA ❑ 0110 /61ms44 <br />-Note efnatmelueNtyl+aewanNras**/ <br />Mary Lanning Memorial Hospital <br />.:: • LOCATION OF DEATH <br />Nastin rs Nebraska <br />ICE -STATE <br />Id <br />'In <br />BEIDE CRY UNITS <br />L t. ❑ <br />Ba COUNTY OF DEATH -.. <br />Adams <br />Nebraska <br />IN coarar <br />Hall <br />ac. CITY. TOWN OR LOCATION <br />Doniphan <br />IN STREET AND NUMBER /eMAMM"°C 8832 <br />- 106 E. Brookl Av =, <br />w -,- - <br />R'I■i Cl <br />,0.--7-get - ow rAra IIMM. Memo one Tt. ANCESTRY .ag.eeeR- MMo-MD, <br />!et Mon.! <br />1 White American <br />1 a USUA.0cQWATWN IKiM.eiydw«adYaab` <br />aT rnlrt, ah a ae Sa etweF <br />N FATSER -NAME FIST MOLE <br />Benhart <br />- TI ass DECEASED EVER <br />GINN% RA <br />14b. Km OF 'moans WOUSTRY <br />Retail L <br />LAST t7 <br />Plvr <br />12 M MANNED <br />L!J <br />■ , <br />e <br />MOTHER <br />Tessa <br />• moons:. <br />[1 <br />FIRST <br />IS. EDUCATION <br />n vM CF Mum aosis ra�Irnlr�t <br />Charlotte (Maser/tar: <br />NOM* NION/u 24INI~ <br />2d'"'°'� °Me' "' «s' <br />PADDLE WIDEN SiMNNE <br />Flessner <br />IYIa no. ea *4.1 <br />715 <br />W M a n IS ager <br />54 U.S. ARMED FORCES? <br />OM t at NW Miss aenaea2 <br />WW II 1942 -1945 <br />Tye. IIFOMAANT -NAME <br />C h a r inFf -s M.. Flyr <br />M11lHD ADDRESS .STREET ORRF.0 NO., CITY OR TO STA TE. ZIP) <br />P.O. Box 284 Doniphan, NE 6 8832 <br />2Q SIGIe <br />EMBALMER - ATRaRE <br />a UCflISE NO. <br />Not Embalmed <br />214 METHOD OF 05FOSI. TION <br />❑BfaYM El Remove] <br />215 DATE • 2tc CEMETERY OR CREMATORY • NAME <br />10 -14 -02 I Westlawn MemoriaL Park <br />22a FUNERAL NOME -NAME <br />Brand - Wilson <br />22G FUNERAL HOME ADDRESS <br />lij Canaan ❑ter <br />2 CEMET€EN OR CREMATORY LOCATION CITY OR TOWN ATE <br />Grand Island, Nebraska <br />ISTREET OR REM NO. OW OR TOMfN. STATE, Lq <br />505 N. Bellevue Jiastin q NR FiR9O1 <br />.AYEDIRTE <br />:.. <br />' (E R O ONE CAUSE PER LINE FOR lal. IN AND tell i <br />PART , anal bRa enMut <br />' Ra' l' a ,i - r <br />- r.' • `1 <br />DUE TO.. F. <br />• Inhomb.ea..«rraa.Taean <br />MI <br />DUE TO. OA ASACONSE• a <br />) <br />` � ,` <br />t [/ trsral Det...anaa. <br />ICI �f 1 / <br />OTHER SIONIflCANT CONDITIONS - c Gi5.on6 <br />PART - b LIB geetll MA MI Telebll <br />A <br />PART N IF <br />FEMALE WAS T A 1 24 AUTOPSY <br />PR EriN ANC Y IF/ THE PAST a HERE McON THSn <br />�n <br />IA9es IO -54I Yes n 40 1111,.. a <br />25. WAS REFERRED ToewIDAL <br />R) <br />OR CORONER) <br />Ya ■ <br />265. DATE OF INJURY /Afa.. <br />❑ Modem la un.. .nee 1 <br />II S.c • Penang s754URY <br />Day v/..1 <br />24) <br />No <br />36c. HOUR OF INJURY 1 26C. DESCRIBE HHOW INJURY OCCt1RRED �/� <br />N 1 <br />Ill Hamlada <br />I Yes ❑ .0 <br />274. DATE TH LW. <br />cu tler;• •• �t .yrm. seem MOM <br />262 LOCATION STREET OR AF D. NO. OTT OR TOWN STATE <br />isi <br />g€ <br />2 <br />29 Ow T� <br />/Ab. Ycl <br />f/JX) <br />r- <br />a � <br />r• <br />2Ba DATE SIGNED (A+. pay YII 7I 221) TAW OF DEATH <br />M <br />275. DATE SIGNED db.. pa Y J 27c. TATS OF H <br />274 To nc bat try a6 Y ear <br />aLMe <br />} <br />YB C PRDNOJ"ICED DEAD 711b Ow Y. f 28d PRONOI/MLEO DEAD 540"u <br />l M <br />/ <br />cM°ggl / r ° 2Ie. On Me base of mammon and w nnN <br />. e .r.aepMan Amnon OMaea aaxlraeot / <br />Me ans. m4 and Face and aae a M cse aRN Salad. <br />anO ' , ' <br />.aE CONTRIBUTE TO <br />31 NAME <br />S 11 1NMKNDWN <br />Al p ADDRESS OF CERiTIFI$R gammen., Op <br />Ma HAS ORGAN OR TISSUE • AT1O7105E4 CGN;JOERED+ <br />r r:Ki WAS CONSENT GRANS IS, NO I <br />R l� <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF- HEALTH AND <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE Q IGINAI.,f2E'CORd bN <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, .VITAL RECORDS; <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. i / ` • <br />DATE OF ISSUANCE <br />MAY 0 9 2913 <br />LINCOLN, NEBRASKA <br />STATE OF NEBRASKA <br />201304119 <br />A. <br />ET NLEY SCOOP <br />ASSISTANT SLAT REGISTRAR <br />. DEPART,MENT OF HEALTH AND <br />HUMAN °.5RVICES', . <br />STATE OP ? AEILD OAr__ALB_,411HR MAN <br />c T 1 11 <br />RS VV9 14 oA CO UNTY ATTORNEY] i Tyyeo, Prater - <br />Paul C. Wibbels, M.D. 115 N K Ave. Hastings, NE 68901 <br />32a. REGISTRAR <br />32a 04.7E FaM3 BY REGISTRAR AW_ QM 1`1 <br />OCT 17 ,2002 <br />