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'9T
<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 ORIGINAL RECORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JUL 2 6 2013
<br />LINCOLN, NEBRASKA
<br />r,. 010808NT. MANE
<br />SUMS OF NEBRASKA- l7EPARIII NrOPHUl.1H HUMAN SERVICES MANCR AND SUPPORT
<br />VITAL STATISTICS
<br />CERT1�ICATE OF DEATH 98 08416 0..
<br />i P? Dt1 OF Do AT Imo (TA V
<br />1 / /?
<br />`Y' , 27b OI'.Te SIGNED (1b Jay Yr! 1 272 TIME OF 3EATH
<br />1 b I--- /f Q! I -1L- •1 A ° S 2 o WO d my k1C•
<br />i .. e•, AC Al AWAIT*. place ace and due roEl e
<br />coos.. MOM.
<br />. r.a5P *And T6e1
<br />tS 01C TJ USE CONTRZU E 19 • THT
<br />I f J 'FS [ N^. fl lNa(
<br />31 NAME AND ADDRESS OF CEnT1FiER iPHYSICIAN. C
<br />Dr. Sitki Copur, 21111 W t r
<br />Fr
<br />( :2A Rc_r,,ISTRAR
<br />e HAS
<br />STATE OF NEBRASKA
<br />4'
<br />201306592 ASSIIS AN ATE REGISTRAR `
<br />DEPARTMENT OP HEAt}'H tgNl .
<br />HUMAN SERVICES
<br />M1[7DLE LAS. 2 SF1 ! 3. DATE OF DEATH NIonst Cla rasp
<br />M
<br />v E`
<br />R S PHYSICIAN OR CO'iA1TYirrosikEV
<br />ley Av Grand Island, Nebraska 68803
<br />eye (MT•,' SYyNED
<br />Og T155irt DDHATON DEER C0R RErr 7Lt HAS CONSENT GRANT t :1 ..
<br />r 2EC RACW: UNCEC DEA L• K• 1xy
<br />tea TPA& OF DEATH
<br />PRON(k,NCE:. DEAD rt^
<br />r
<br />ap 0" me bon '• pow•Proo, ono 01 51'.r '0Mr.. c ✓MC
<br />h. ro 554 one 0900 ant 7oP 10 Y! moon SAW
<br />S,FVe.Ae An0'PP.;
<br />Ei vE Lli--
<br />32^ _ATE FILEC B! 48'3.3.'8A= No (O. v,
<br />JUL 1 61998
<br />M
<br />N`
<br />L Robert epk, Grennan
<br />Male ! July 10, 1998
<br />d C 1rr AND STATE OF R771 Al nets U3A. emeeseueele
<br />St AGE- t2Mio7ity' U14DER1 YEAR
<br />UNDER( GAY
<br />S. WTc OF BIRTH Mb*tlIY KN./
<br />August 26, 1924
<br />• -r ad Islaueicraska
<br />rvrsl 5b MOS. 1 DAYS
<br />73 1 ,
<br />Se. HOURS• MretS
<br />7 s.Zer..k. SECURIF. HAMA �..
<br />506-20 -2803
<br />ha PLACE OF DEATH
<br />H.-cRTAU C rneeam OTHER: 111
<br />lYoaal9 Horns
<br />......rwe
<br />Dow lsoecM,
<br />:.-
<br />Ib. FATSL!TY - NANA ATTAMmeMulme IM sew wei matey
<br />St. Flrancia Medical Center
<br />0 ER O, MR
<br />0 DOA
<br />0
<br />■
<br />es CRY. TCNN DR lJCADON OF DEATH
<br />Grand Island
<br />84 a1SiDE CITY OATS
<br />Yes El NP ❑
<br />Se. COUNTY OF DEATH `"—
<br />Hall
<br />9a RESWENCE - STATE..
<br />Nebraska
<br />90 .•
<br />Hall
<br />9c. CITY. TOWN OR LOCATION
<br />Grand Island
<br />90. STREET AND NUMBER rn cka8TDZACaON
<br />2520 W. Division, 68803
<br />90 INSIDE CRY LIMITS
<br />Y« No 0
<br />10. RACE • tag- Mw. Black. Amman Indian.
<br />!i "'
<br />11. ANCESTRY talc. Men. MARCan. Gesaa MO 1.
<br />A riean
<br />12. MARRIED •
<br />N MARR1e EVER D j fl
<br />WIDOWED f 13 NAME OF SPOUSE ie.le.. pW y
<br />esadon
<br />0IV0RCED I Helen Alexander
<br />,. 40 USUAL OCCUPATION 1G.,e isda!orlr OMkg ngol
<br />a7 KOrt:rg /it nineteen's"
<br />Switchman $
<br />140 KM OF BUSINESS INDUSTRY �,(�
<br />Ll a n�
<br />Union pacific Railroad
<br />/S. EDUCATION 'Span only tnplIMgwke,0W11M91
<br />EN ID or Secondary 10 -12) College 11 -A or 5.1
<br />L �1 5. FATHER• NAME FIRST MEDDLE LAST
<br />Frank Grennan
<br />IT. MO ?HER FIRST MIDDLE MAIDEN SURNAME
<br />I Nellie Wiley
<br />71 1 9. WAS o*CEASED EVER 04 U.S ARMED FORCES?
<br />)Y85 n0 0(W Ill 9Ve* Tea0483aI945I.
<br />Yes: Il 3 -20-43 Yi -23 -44
<br />19a. INFORMANT -NAME
<br />Helen Grennan
<br />ISb. INFORM*? MAILING ADDRESS (STREET OR R.F.D NO. CITY OR TOWN. STATE. DPI
<br />2520 W. Division, Grand Island, Nebraska 68803
<br />2F] N. S95NAT Re ENSE
<br />0
<br />21A METHOD OF DISPOSITION
<br />® Burial 0 Removal
<br />121b. OATS 1 21c CEMETERY OR CREMATORY NAME
<br />07/14/2998 Grand Island City Cemetery
<br />um. N
<br />Apfel -B itier- Geddes Funeral Home
<br />❑ (-Ammo • Docalbn
<br />21d. CEMETERY OR CREMATORY LOCATION CITY OR TJIM STATE
<br />Grand Island, Nebraska
<br />225 FUNERAL HOME ADDRESS (STREET OR RFD NO. CITY OR TOWN. STATE. DPI
<br />1123 West Second Grand Island, Nebraska, 68801 -5899
<br />27 IMMEDIATE CAUSE
<br />., PART
<br />/ (ENTER ONLY 0 CAUSE PER UNE FOR far lb). AND 151 , { ammo! bowmen OHIO and (seam
<br />'e � J `Nt +o -Lire, tb ,�' �" q.1 Ce.4
<br />DUE TO. AS A CONSEOUFNCE OF mMr,a1 belaKan anew and seam
<br />Q :
<br />(.1 1
<br />DUE TO. On AS A CON OF' !mr+m beMen noel and pear
<br />r — OTHER
<br />SIO.NIFK;ANY CONDITIONS - Condemns c0nmb4ngto me LAMM but rof mlpea P AHI , n11 F5YAALE WAS THERE A ; 2A AUTOPSY 1 25 WAS CASE REFERRED TO MEDICAL
<br />PANT
<br />1 PREGNANCY IN THE P 3 MONTHS EXA1e1ER OR CORONER'
<br />N ri
<br />AO. +5 541 VAt No YC 7N.' Yes ❑ No
<br />� ��--
<br />( 262
<br />[1 Tecdae 0 (r hale *.'knee
<br />Li S,K46_ 0 Pero•nc
<br />( (I , wr.coPe Inver I(kA'
<br />Mb DATE OF INJURY y. W JLWY !M7.. D, 1 E1 TY - , Te INJURY €SCRIBE HON OCCU: RED
<br />I5c HOUR OF ,fL9
<br />1 u L
<br />126e NA) AV AT WORK
<br />YES. Nb 0
<br />120 g usV% wm r
<br />/rm V•e t• -7,, i:CATiON STREET c7•+ A F 0 NO "•,, OR TOWN STATE
<br />'9T
<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 ORIGINAL RECORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />JUL 2 6 2013
<br />LINCOLN, NEBRASKA
<br />r,. 010808NT. MANE
<br />SUMS OF NEBRASKA- l7EPARIII NrOPHUl.1H HUMAN SERVICES MANCR AND SUPPORT
<br />VITAL STATISTICS
<br />CERT1�ICATE OF DEATH 98 08416 0..
<br />i P? Dt1 OF Do AT Imo (TA V
<br />1 / /?
<br />`Y' , 27b OI'.Te SIGNED (1b Jay Yr! 1 272 TIME OF 3EATH
<br />1 b I--- /f Q! I -1L- •1 A ° S 2 o WO d my k1C•
<br />i .. e•, AC Al AWAIT*. place ace and due roEl e
<br />coos.. MOM.
<br />. r.a5P *And T6e1
<br />tS 01C TJ USE CONTRZU E 19 • THT
<br />I f J 'FS [ N^. fl lNa(
<br />31 NAME AND ADDRESS OF CEnT1FiER iPHYSICIAN. C
<br />Dr. Sitki Copur, 21111 W t r
<br />Fr
<br />( :2A Rc_r,,ISTRAR
<br />e HAS
<br />STATE OF NEBRASKA
<br />4'
<br />201306592 ASSIIS AN ATE REGISTRAR `
<br />DEPARTMENT OP HEAt}'H tgNl .
<br />HUMAN SERVICES
<br />M1[7DLE LAS. 2 SF1 ! 3. DATE OF DEATH NIonst Cla rasp
<br />M
<br />v E`
<br />R S PHYSICIAN OR CO'iA1TYirrosikEV
<br />ley Av Grand Island, Nebraska 68803
<br />eye (MT•,' SYyNED
<br />Og T155irt DDHATON DEER C0R RErr 7Lt HAS CONSENT GRANT t :1 ..
<br />r 2EC RACW: UNCEC DEA L• K• 1xy
<br />tea TPA& OF DEATH
<br />PRON(k,NCE:. DEAD rt^
<br />r
<br />ap 0" me bon '• pow•Proo, ono 01 51'.r '0Mr.. c ✓MC
<br />h. ro 554 one 0900 ant 7oP 10 Y! moon SAW
<br />S,FVe.Ae An0'PP.;
<br />Ei vE Lli--
<br />32^ _ATE FILEC B! 48'3.3.'8A= No (O. v,
<br />JUL 1 61998
<br />M
<br />N`
<br />
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