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EMILIE
<br />rr -I, S., " ,"
<br />M u4, .NJ (T..«y)
<br />White
<br />ANNA HAFFLET
<br />a _ - .1"1-.'T'-.- IR..., • )..tea.. —WM wAil.,
<br />.k.)(s..c fi L (^')
<br />s Aszrica ¢ 1
<br />iL . fl AL..
<br />J_ 23 1• :5
<br />-° 11 . _ 4w., , r..)
<br />J 4 1 :
<br />Ow AND SATE o e i+► ..e va. ., ff cIT12EN OF WWII COUNTRP'
<br />L#aa► , Nebraska I,. U.S.A.
<br />1 , ldoyd ►rs•«+h)
<br />NARAE • OM w.5.)
<br />n . 1''x'ed H,attle / (dec)
<br />wan
<br />12.550- 2
<br />',WM OCCUPATION /lad Jas. Jwiiy wr
<br />of
<br />f lee. Produce Heidi. (77
<br />•
<br />KIND OF N )IINI $$ OR /
<br />I3.rairmoat Foods
<br />COUwa1.OF
<br />1
<br />vIA TN
<br />. Hall
<br />Ci19, TOWN CS LOCATION OF DEATH
<br />INSIDE art LIMITS 110S*ITAL OR OTHER INSTITUTION - Nome (Neer )a.iM«•
<br />; Tea at a N�an Medical Center
<br />• 1101P.
<br />1i1 ,Qas nd Island, Nebraska
<br />( .
<br />,... Inpatiennt
<br />REIDDINCE -STATE
<br />Is.. Nebraska
<br />COUNTY ►CITY, TOWN OR LOCATION
<br />ls.. Hall 11se.Grand Island
<br />STREET AND NLMISER
<br />isa. 1308 W. 6th. St.
<br />INSIDE CITY LMU'S
<br />Y.. or NY
<br />1s.. es
<br />—'
<br />ID. Julius
<br />ANDOIE LAST
<br />NMI Nathan
<br />MOTHER - MAfD84INAME FIRST MIDDLE LAST
<br />17. Louise NMI - Mueller
<br />WAS DECEASED EMER IN U.S. ARMED mmeCEm/
<br />rt...... «.4)1(111 ,«. •i ue, f5N dews 9f e.vk.)
<br />1.. No N/A
<br />INFORMANT- NAME - RELATIONSHIP - MAILING ADDRESS Mate OR cry. NO.. CITY OR T yDE. tin
<br />��" + "�' + a
<br />l,.Marie Bartee- daughter -1308 W.6th. , Gran'i Island, Ne.
<br />SUO MI. Cremation, Rnawd
<br />as.. Burial
<br />DATE
<br />zap. July 26 1985
<br />CEMETERY OR CREMATORY - NAME
<br />20,Westlawn Memorial Park
<br />LOCATION CITY OR TOWN STATE
<br />2Dd. Grand Island, Nebraska
<br />- SIGNATURE II UCENSE NO.
<br />s ii : f
<br />FUNERAL NOM! -NAME AND ADDRESS (STOUT OR R.r.D. NO.. C'TY OR 'Owe& STATE, 21.) 68goi
<br />22.Livi • : ston- Sondermann Or W. Kota : Grand Island, Ne.
<br />. , Day, n.)
<br />23 ; July 23, 1985
<br />I
<br />A < .T .' .. y, ..)
<br />24.1.
<br />, ..-r . .
<br />2,b M
<br />DATE SIGNED (M.., D.)' Yr.)
<br />• f
<br />MOUE Of DEATH
<br />x
<br />23c. 3:30 P
<br />.
<br />X
<br />I .
<br />i
<br />EY)
<br />iD
<br />PRONOUNCED DEAD
<br />(No., Day, Yr.)
<br />2
<br />PRONOUNCED DEAD Mow/
<br />)M
<br />c.« 14. ewwe ' N..M marred el M. N... Rees ..e ..e de. p. M.
<br />-
<br />r. . ..1 new ` - T
<br />MwAew.., i...yy b.n� Named es
<br />O. :Iberia .Mwi..
<br />di. N.. f. ..d pl. ...e e.. wNw .. ...Ii .wl...
<br />211. (Sie..w. . ..1 INN.) •
<br />(Type a Mot)
<br />GiefehfrZ if i‘/.) fr
<br />_ . [SiM.t ' . .. T!' ..�
<br />. Zz "�* s' LAN, • •+•, IAN QU A
<br />,.e S ; ' MA/ LJ U I BM -(/S'► o 2-if of rf e
<br />''•t" • T (
<br />tie. [Sie..wrN Il
<br />DATE PSC SY REGIS (AI.., D�Y��
<br />2 / .is
<br />27. IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE LINE FOR (a), (b) AND (c)) i I.wr..l ►as...n.r *NA
<br />Lads
<br />• A ••. r > 1 E /
<br />f)N , j . l a
<br />4-
<br />ODE TO, OR AS A CONSEQUENCE Of: I.f.r bfnr. ....f ..e e..a
<br />W
<br />PART 001E11 S10NMICANT CON14TlOH$- C..dinem c...ib.ti.e Is e..M lief not ..l.Me
<br />[ o 11*7 111.. 11 P' "4 R As M RE ANSY
<br />f l Yes ❑ N. ❑
<br />AUTOPSY « « N.1
<br />2S No
<br />WAS CASS oR cow:~
<br />Sootily NOTRCAM
<br />p i� r« r w.)
<br />ACCgs.. Swamm, 110516)11, UNDET..
<br />Oa' FWIEMI0.W1?TI0A10ON. (Specify)
<br />TDAT1 or auURY [M., O.,, Y..) 'Hoot
<br />3O1).
<br />Of N10*7
<br />SOe. Al
<br />ORSCNS§ NOW INJURY OCCURRED
<br />30d.
<br />AT WOWS
<br />(1,.dfy I.. or NN
<br />301
<br />RACE 0) MUURT- As - w, f..., a...f, ).awry,
<br />,His b.ieiteg. «c. (Specify)
<br />301.
<br />LOCATION STRUT OR R.f.O. N.. CITY OR TOWN STATE
<br />DATE OF ISSUANCE
<br />SEP S 0 2013
<br />LINCOLN, NEBRASKA
<br />201308114
<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENZ'6
<br />HUMAN S E R V I C E S , IT C E R T I F I E S T H E BELOW T O BE A TRUE COPY OF T H E Q 1N I LW 7
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVIC,E'S ORciS`f,
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. -;<; I • ;• `'
<br />STATE a 1 � - MTMINT OF SEWN I M. swims
<br />CERTIFICATE OF DEATH � t
<br />51 `ANLEY
<br />'ASSI5TA
<br />DE RTMENT OFHEAL
<br />f,Ul N. VICi ,
<br />' 1 LY [
<br />• r,i �.
<br />tfOR
<br />HAD.
<br />
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