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PHS- 70flVBl REV. E -37 STATE OF NEBRASKA~ <br />DEPARTMENT OF PUBLIC HEALTH, DEPARTMENT OF HEALTH <br />EDUCATION AND WELFARE BuI a of Vital SWtistlm 1 <br />BIRTH No 126-- ...... CERTIFICATE OP` DEATH STATE FILE NO <br />1 /LAO[0 /DLATM 7 A STATE <br />IKSIDLML[II[r. Ir....1 i,r1 IJ,..IU.I.� Rr,M.r Wr•.drww) <br />. COUNTY Hall �-/ �� . STATE Xgw br D COUNTY ny„ A <br />- f. CITS'. tOWN.U*1 Al— LLNUTN CM STAY I"" I CITY TDWN.YR11L«rT*" '1W <br />GrandIsland I 1 deg ceiro <br />�. RAME or IN nW uI "WIA' I rrtl o,Cv— . S-11 --S <br />NosrrTAL w <br />s M :717YTDN St. Francis Iiospital <br />NOO <br />S. R PLACE M DCATM INSIDE CITY LIYITSI YES MOO I IS RESIDENCE INSIDE CITY I.—TSI YESV j/ FARM RESIDENCE? YES <br />❑ <br />IJO t J <br />MAY[ M f7r. Mida1 Low– [ DATE M-11 Dy Yra <br />OILGtL. <br />Inl..r p(w) Adelia ,-y Wiese r" Ap ri <br />f aK f COLOII W MQ 7 MAR.YD L.] N[Y[R MARRIED [ f DATE Of W.T. 9 O[ I In ".1. 1 . Yn00I r[M Y At Ills <br />tatnal a J white IAN AntMal) Y W x .r Art.. <br />WlDOrrD❑ wvwcm 2/4/1898 84 <br />`JOS USUALOCCUPATIOMIGlw lids /MO.L Pow 101 RINDa wsINEssWIMDUSrir 111 aiRTMiuu l9Wa a/ortlP mnlMn) It uLeas WwT muinrr <br />p•iy .aWUWDrily tot. IJ1'1`7 11 <br />fe a y <br />I 4. . usS i <br />I I.. IUY[ a MYSRANO OR Wlf[ <br />Henry Li).enthaa I u- .??,own Gu1�og illis a igse <br />'f WAS D[CEASCD EVER IN Y S ARMED FORCES? is SOUK "CORITY ND IT INroRrurt Add.Iw <br />re.w.a..[ —i dl,.....wr1.w✓ -- <br />po r {4g•q Mr. 'William H. Wiejj <br />U fAYY a EYATM 1 P.1/ aw [[T <br />fAR71 DEATN WAS CAUYD A� A,- T, <br />j IMMEDIATE CAUSE I.) '°�^a^'� A A L j J - <br />.! �lcbnf41aw. 1 /aq, Dug -To(f) L" Y vv^ _- Xd��� <br />s �Y�I etyr iW- DuE To ( <I < ' I° /d dA <br />PART 11 O?rq SMMDKYrt CwainY ConMUrwE ' DuM RIR 1[a R[IARD TO TN[ —.0 XL CnIMrnN OI— IN r�RT i(.1 IY WAS AUTCRW <br />/J rEUCNI NEYT <br />_ r[s❑ <br />D)[:, AECID[NT SUICIDE NOMICIDE 7m DESCAIRE MOW INJURY OCCURAED IERIrt nWUK .J IAJ.O h Part /O POSE 17UUI� ILI . <br />❑ ❑ ❑ <br />AIR TIM[ OI Hw< .VI.r1, Dy. Y. <br />INJNRY R. w. <br />s !. P. <br />Ia INJURY OCCURRED 7111 r4CE a IN)URY Ir /. h W da.t 1.AM. 7DJ GT. TOWN. OII LOGTION COUNTY STATE <br />w ME A: ❑ Nor —I. ❑ FLhC hdoll. d.ryl, o�iw u= -AM. <br />T WORK Al WORK <br />a ,l REbn�.�J Qaceuad Iro to L['`E 4 ^ �7 Z ntl /u1 ue A n .Jn. aN <br />T ll..tA I.d et _. Ilu d.t..t.t.d.bogt,.nd to tho beat d mf Anoe J.dd., frum Ihr u.w .t.I d. <br />111. DAR SIGNED <br />�IrV .� Y- L[ ill WANE Of CEY[TERY OR CR[NATDIIY 11 TION ICU /. /wuR. w [aunll) (SIdI) <br />�r11 L• - "� P"'/" _8 2/1962 17ratlawn re o r,- <br />x)dl;l� Rra� -1Ceh_ <br />A[yX RY REDISTlRR Ff, RAR151DNETUM/ lY/J Y NAYS Of YOfun ODRfO <br />ti - /ir�/�• / /E! Apfel funeral Home, Cairo 1Cebr. <br />