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201308903
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8/19/2014 2:24:33 PM
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11/7/2013 4:15:31 PM
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201308903
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-Tit _ <br />Clarence Marvin Anderson <br />a SEX <br />Male <br />$ 517270PleiRN WV•fec OP, *0 <br />Augugt 11, 1997 <br />Grand Island, Nebraska <br />$, A L ot &kw <br />mw 72 <br />wow 1 <br />- gw - r a i,Dos <br />WNW I pm <br />"ow*: aa <br />a AM OF WirI4 NW* Aw *al <br />March 1925 <br />, scow. WicUmw sijw <br />508-18-8900 <br />i Ow RAW OF ofA <br />pwwww.: <br />II MPIIIIM OTHER 0 *MAR HOAR <br />0 ER CliesIAM 111 Emidena <br />0 000, 0 matemaa, <br />- ,* -,fta. asliikt. Oa OW fola/alm. <br />- 72 Kuester Lake <br />ig. arc law% Ow ustwwyt anew <br />Grand Island <br />..r <br />s <br />70 4E1910 i,•4 <br />Cower 00 maw <br />Hall <br />- Ji0 <br />Nebraska 1 Hall <br />1 0. MN • WD. 24i49. ANNWIR <br />Mal taINKAM <br />White <br />• <br />tt, SNOW& 04. Maw <br />American <br />Grand <br />- SIAMML <br />le - 7-• <br />Island 172 Kuester <br />WA to 1 tiDD CANNEW 0 MOM) <br />1 MI =T. °4° <br />1 , - ZOOMS <br />Lake 68801 <br />13. NUS OF SPOUSE Omit pientielp <br />Shirley Herzog. <br />,•-: .. r <br />Y404E+Nori <br />row) <br />tila UOIALOCCUPARON lehehlafrewoftermorAVAVisal gr* <br />thimmtma remirmhme 0 <br />sales Manager <br />..0 <br />046 WOOF SYMMS INDUSTRY % <br />Proctor 6 Gamble aP <br />IS EDUCATION OWN* NIN memo ommi ammimom <br />A -144* WIT <br />Marvin Conrad Anderson <br />17 <br />, MOTHER RR ' SURNAME <br />Dorothy Marie Sievers <br />it WAS mum <br />Yes """ <br />gval g, u.s. meao ft~ pi. iNPONNANT • <br />1 " In 7-1 TM/T-46 1 Shirley Anderson <br />tat 4 424244*? MUNN ADDRESS 'SWOT OR RI 0 NO., tiTY raw E. aft <br />ster , k . Grand Island, Ne. 68801 <br />..• A l f I'"» <br />ra <br />, <br />mermom of • , - 1 ----", <br />Stb. DATE 21c OR CRENATORT • NAME <br />Aug.15,1997 Grand Island City Cemetery <br />Livi gston-Sondermann F.H. <br />-- dniarirp.0. <br />Damao 1111 <br />210 CEMETERY OR CREMATORY LOCARON COY OR TONN STATE <br />Grand Island, Nebraska <br />7 I"' • • r. • No CRY CR T• <br />601 N. Webb Road, Grand Island, <br />.S ATE. Eel <br />Ne. 68803-4050 <br />wi. CAUSE IENTER (pm OW CAUSE PER UNE POP AR SR AND NS MONS MAW SW aml dimM <br />414424 # A /5 MORI 141 <br />Ol TO. AS A CONSECIUSOSE OP <br />NI <br />DUE TO : • AS A CONSEQUENCE OP Waal 0010000 ova ono MAP <br />te4 <br />ODES SIONMEANT CONDEMNS • Condom sorWANW0 aro MOON net WNW <br />PART <br />II <br />PART NI IF PEANSE. WAS THERE A <br />PREGNANCY IN THE PAST 3140147148' <br />10.041 Ws No <br />24 *UTOPIA <br />)..... <br />les wo <br />20 WAS CASE WNW 0 TCit <br />EXAMINES OA <br />..V vas n pia <br />0 0 uraporromd <br />0 swami 0 Pwchng <br />0 MARVA INMsbaMon <br />3. 0478 04 RIMY ft. Datt WI <br />lee HOUR OF 'NAM al MOINE NOW INJURY OCCURRED <br />20. OuuRY AT WORK I 7* pal Amor hwn. wow mar/ <br />...‘ Ves 0 No 0 I <br />260 LOCA1 0 STOWE', OR 9 4 0 NO CITY OR TOWN STATE <br />.:. <br />g <br />I - - <br />20 ow Towcua <br />IX <br />274 0474 04 DEATH No !iv v <br />A' August 11, 1997 <br />ND DATE SIGNED No Day 4, ! <br />09*, we Of DEATH <br />In DATE WINED Mb Dar yr i <br />August 13 l'• <br />27e TAR OF DEATH <br />10:30 AM, <br />Me PRONOUNCED MAD :AR DIA WI <br />349 PRONOUNCED DEAD rtioun <br />ki <br />on 0101000 And Plow eke w eis <br />...Jew, <br />aft 0 IND saw of wwwwbon aro w cwwwwww. w eny opnuon death °mewl al <br />ON brtw (WNW Noce and dot NEN caweIN NNW <br />• <br />..,.. NW Teat_ <br />USE CON TRE DEATH? <br />0 YES ' 0 <br />30. HAS ORGAN OR TISSUE DONATION SEEN CCNStDERECP <br />A...... 0 YES NO <br />300 wAS CONSEN 0RA0140 <br />4" 0 YES VI NO <br />31 NAME AND ADDRESS OE WIRIER IPHYSICIAN. CORONER 5 PrciwoAN oR COuNT7 ATTORNEYI / Type°, <br />. — -- ......---. ......-- _ - <br />.,1-, John A Wagoner Jr 9 800 Alphg Street, Grand Island Ne 68803 <br />, ' V(IICTIM■ -0 <br />STATE OF NEBRASKA <br />4 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPART <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SE <br />RI TO <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />DATE OF ISSUANCE <br />NOV 0 4 2013 <br />LINCOLN, NEBRASKA <br />201308903 <br />STAVE OF ONOIRASKA 011PARTIMIIIT O HEALTH <br />UMW OF VITAL STATION:6 <br />CERTIFICATE OF DEATH <br />32b DATE 49.60 37 RIM 8 war <br />TRAR <br />THAND <br />6 2 <br />
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