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<br />COD
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<br />° CD
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<br />CD ` CD. ,
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<br />TYPE OR PRINT IN
<br />FEYAANENT INK
<br />SEE INSTRUCTION
<br />Place
<br />NSC.
<br />War*:
<br />MANUAL
<br />Italic -
<br />8
<br />C
<br />Part II
<br />CaEaes_Tract No.
<br />$Ysl .: : 0EOi11.e%S 1242
<br />STATE OF NEBRASKA- DEPARTMENT IV RIALTO
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />W
<br />i
<br />• DECEDENT -NAME FIRST
<br />, BERNARD
<br />RACE —Coq., White. Bloc#. Aws.ieeo
<br />Indian, ets.) (Specify)
<br />White
<br />4.
<br />CITY AND STATE OF BIRTH Of net in U.S.A..,
<br />rronte cov hP)
<br />B. Omacia, Nebraska
<br />SOCIAL SECURITY NUMBER
<br />12 507 -22 -5852
<br />CITY, TOWN OR LOCATION OF DEATH
<br />Grand Island, Nebraska
<br />RESIDENCE —STATE COUNTY
<br />,g Nebraska In, Hall
<br />FATHE
<br />16.
<br />R —NAME F( T
<br />Joseph
<br />MIDDLE
<br />W. Pulte
<br />LAST
<br />WAS DECEASED EVER IN U.S. ARMED-FORCES?
<br />;Yon, no. a..MI (If yes. 9son i.. . ae Moot N noose)
<br />, Yes ( WWII 1944 - 1947
<br />BURIAL, Cremation, Removal
<br />20e Cremation
<br />EM LMER— SIGMAfU i UCEN NO.
<br />2T. 4 11,4/ /f� G4e
<br />TE Of DEATH (Mo.. , Yr.)
<br />li
<br />14
<br />s
<br />►
<br />clstRAR
<br />(b4
<br />R
<br />23aX Y- "
<br />DATE (M
<br />E SIGNED e.. Day, Tr.)
<br />2315` TEv
<br />Ti Me Yore In..Fed9a. 4,47E lEr at IM Mee dim ead Mow so dm M.
<br />toteNd tLN4. \
<br />23.),(Si,.ehrt sad NOW
<br />DUE TO)E /IB A CONSEQUENCE OF
<br />ACCIDENT. SUICIDE. NOWCIOR, UNDET
<br />OR PENNING INVESTIGATION, ( Speedy)
<br />30a.
<br />INJURE AT WOW
<br />IS.e.Up I'm or Net
<br />30e.
<br />MIDDLE
<br />JOSEPH
<br />OBIGIN/OESCENT (.. ., belies. Maaican,
<br />(Seec
<br />American
<br />CITIZEN Of WHAT COUNTRY
<br />, . U.S.A.
<br />AGE —wt Biondoy
<br />(Yrs) 61
<br />60.
<br />USUAL OCCUPATION (Give kiwi el ewe den. during east
<br />~kiwi el P n ea ger
<br />DATE
<br />201 ,Aug. 5,1987
<br />•
<br />John J. Cannella, lam-
<br />INSIDE CITY LIMITS
<br />(Speak Ye. cm Ne)
<br />14c.i
<br />DATE Of INJURY /MS.. Ow. Tr.l
<br />30►.
<br />HOSPITAL OR OTHER INSTITUTION — Now. (If net in *ilk.,.
<br />give Efriret rancis Medical Center
<br />CITY, TOWN OR LOCATION
<br />Ix . Grand Island
<br />INFORMANT — NAME - RELAT,ONSH:P— MAILING ADDRESS
<br />19. Helga Pulte -wife -2410 Gateway Ave.,Grand Isl d NE
<br />CEMETERY OR CREMATORY — NAME LOCATION CITY OR TOW
<br />I
<br />2 0 c Central Nebraska Mignon o n 2Qd. Gibbon, Nebras
<br />HOUR OF DEATH
<br />21 . /s
<br />A ,9 M
<br />NAME AND ODRE $ I 1OF CERTIFIER (PHYSICIAN, CORONER'S PHYSICIAN OR COON
<br />729 North Cuter
<br />/t)
<br />e OTHER SIGNIFICANT CONDITIONS— C..deieee c.tord a ng N MGM Ye met ..toed
<br />260. (Sigeetwe) D�
<br />IMME � A E CAU? (ENTER ONLY ONE CADS FE U FOR (e), (b), AND CO
<br />PART PA (` p e
<br />i.) CAI) ` h—Z� e+n - J t r M1
<br />DUE TO. OR AS A CONSEQUENCE Of:
<br />te
<br />MACE C, "way— M. we. Iwo. moot. fe.N.Y.
<br />.Ilia. it.il/M WR. " (EMdfP)
<br />30E.
<br />LAST SEX
<br />PULTE ,Male
<br />3.
<br />UNDER F YEAR UNDER I DAY
<br />MOS. DAYS HOURS MINS.
<br />Pb. I6c.
<br />MARRIED, NEVER MARRIED,
<br />WIDOWED OIVORCED(Sp.cify)
<br />,0. Married
<br />30 ..
<br />KIND OF BUSINESS OR INDUSTRY
<br />Cargill Nutrina
<br />13b Company
<br />a
<br />NODE Of INJURY
<br />30e.
<br />LOCATION
<br />30d.
<br />„Helga Gress
<br />COUNTY T DEATH
<br />Hal
<br />14e.
<br />It NOSP. OR INST. Inch
<br />Oet ssiant /Enwr I n I
<br />14 e. Inpa t ien
<br />STREET AND NUMBER
<br />,s,(: 2410 Gateway Ave.
<br />MOTHER— MAIDEN NAME FIRST
<br />1 7 Cecilia NMI
<br />DATE SIGNED (Me. Dey. Yr.)
<br />24e.
<br />PRONOUNCED DEAD
<br />(Me.. Day. Yr.)
<br />2Ac.
<br />U 24e. (Deemer. end Flea) b.
<br />ATTORNEY) (Type w Pnnf)
<br />Grand Island
<br />PART W. M FEMALE : WAS MERE A AUTOPSY
<br />PROGNANCY RADOM/SST 3NONTHST (Speedy V.. er Net
<br />Y «D re 2B.
<br />ERIE NOW *DUEY OCCURRED
<br />1
<br />STREET O.1.0. Ni.
<br />.E
<br />(STREET OR RD. NO., CITY
<br />HOUR OF DEATH
<br />24b.
<br />MIDDLE
<br />Lee
<br />PRONOUNCED DEA
<br />Nebraska 683
<br />DATE RECEIVED BY REGISTRAR (Me., Do
<br />29.
<br />eo Mt.
<br />Wone.n
<br />Nn w
<br />Inel beare
<br />)
<br />CD" OE
<br />DATE Of DEATH (Me., Day. Yr.)
<br />August 2, 1987
<br />DATE OF BIRTH (MO. Day, Yr.)
<br />March 24, 1926
<br />NAME Of SPOUSE (if wif., give moidon nom.)
<br />a.. DOA,
<br />110.1110.100 e.N (Speedy)
<br />t
<br />INSIDE CITY LIMITS
<br />13.t L A S T- orNa)
<br />i V
<br />OR TOWN, STATE, ZIPI '
<br />an 68803 W
<br />N STATE
<br />ka
<br />FUNERAL HOME -NAME AND ADDRESS (STREET OR R.F.D. NO.. CITY OR TOWN, STATE, ZIP 68801
<br />2 Sondermann,505 W.Koenig,Grand Island, NE. w
<br />M
<br />D (Hour)
<br />• 24d.
<br />2 M
<br />V Os M win d a Moto owcien d.. I ion.M9etia ' my topiniew down occurr.d et
<br />Ike RIM, deN OW View end 4w e• IM Rove ge stowd
<br />3
<br />, Yr.)
<br />I. »MI b ss..n Mutt and dm*
<br />onset end Moth
<br />saw end deeM
<br />WAS CASE EEFEERED TO MEDICAL
<br />EXAMINER OR COEONea
<br />MSpwdy re. a Ne)
<br />TOWN STATE
<br />
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