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1 DECEDENT • • NAME FIRST MOOLE LAS! Baasch
<br />Linda Mae Baasch
<br />SE%
<br />Female
<br />3. t7rsiE OF DEATH Moran Oar v*,
<br />t 10, 2003
<br />A. C1tY AND STATE OF EARTH 1Nnoo, USA na11*co t
<br />Grand Island, Nebraska
<br />7 SOCIAL SECURTIV
<br />Sa AGE • Last BaeldIy
<br />'YB. 64
<br />UNDER 1 YEAR "�
<br />_ June
<br />UNDER 1 DAV
<br />6 DATE OF BIRTH /E II1Ft DAY 0 1'51
<br />October 10, 1938
<br />se Mob ' DAYS
<br />Sc HOURS "°"15
<br />NUMBER
<br />506 -40 -1331
<br />i l.......
<br />81' PLACE OF DEATH
<br />HOSPITAL ❑ lE OTHER [] Naaag Horne
<br />m F0' lLITY• Narrta (N nay AsNueotL gweseemand mewed
<br />3180 South Blaine Street
<br />❑ Eq Q.nwn«a
<br />❑ DDA III
<br />Rabdence
<br />1'e rsde�r"
<br />4: CITY TOWN OR LOCATION OF DEATH
<br />Grand Island
<br />133
<br />NSIDE CITY LIMITS
<br />V E3 No •
<br />J)e COUNTY 00 DEATH
<br />Hall
<br />So RESIDENCE - STATE 9, COUNTY
<br />Nebraska Hall
<br />,c CITY WHIN OR LOCAT ION
<br />Grand Island
<br />SO STREET AND NUMBER (*1CIl rgZat Cade/
<br />6 8801
<br />3180 South Blaine Street
<br />So W SIDE CITY LIMITS
<br />"6 4° ■
<br />10 RACE N9.. wood Sac6 Anentrlfndlan 11 ANCESTRY leq eMrl.ANa Getman. at T x MARRIED ❑ WIDOWED
<br />ele I iSaaddyl ! ISnecdyl
<br />White Danish 1 ❑ M ARR NEVE I R ED fl OwORCED
<br />13 NAME OF SPOUSE /OH* any a maaienmaw)
<br />Bill Baasch
<br />14a USUAL OCCUPATION ,aeeh.ndee drueurn, a.or
<br />dworwgAle '0'
<br />Bookkeeper
<br />145 5010 OF BUSINESS 0DUSTRY
<br />Bill Baasch Welding
<br />15 EDUCATION ISPecN only ngh,p grade 005,,Mled)
<br />EJenentr, or Secendry 1012) College f 1.40, y•1
<br />12
<br />1e FATHER• NAME FIRST MIDDLE LAST
<br />Edmond Van Trump
<br />!" MOTHER FIRST MIDDLE MAIDEN SURNAME
<br />Alice Reinecke
<br />16 WAS DECEASED
<br />Ivies no ce Lira') 1
<br />no
<br />EVER W US ARMED FORCES
<br />In yes awe war am ewes daemon'
<br />I fga INFORMANT. NAME
<br />..
<br />Bill Baasch
<br />11b INFORMANT MAILMEG ADDRESS ,STREET OR000 NO• CITY OR TOWN STATE 241
<br />3180 South Blaine Street, Grand Island, Nebraska 68801
<br />20 EMBALMER • SIGNATURE & LICENSE NO
<br />/ /3.�5
<br />218 METHOD OFDISPOSITIO, 1215 DATE 211 CEMETERY OR CREMATORY 114045
<br />® &n,4 m
<br />❑ Reov.y J June 14 2003 !Grand Island Cemetery
<br />22. FDNEAAL . .IyAME
<br />Aefel- Butler- Geddes
<br />225 FUNERAL
<br />1 210 CEMETERY OR CREMATORY LOCATION CITY OR TOWN STATE
<br />❑ Denman ❑Donato'
<br />Grand Island, Nebraska
<br />.i
<br />HOME ADDRESS ISTn..2T OR RED D NO CITY OR TOWN STATE. 2101
<br />1123 West Second Street Grand Island, Nebraska 68801
<br />23 IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR a: ■51 AND (01, Inlet 4I between 0154 and rWaa'
<br />PART
<br />1 l81 r nGe 1 i - r - 51.,(.5 M ,� u.r a pprO r. 2 Wee ms
<br />DU TO.OR AS A CONSEQUENCE OF
<br />In e,ar between onset 0 l nom
<br />5, itoct ress(vc. su,bcor4 -r'c+at d me He
<br />4pp 5' !tear 5
<br />DUE TO OH 55 A CONSEQUENCE OF
<br />Irner.a between onset and ;lawn,
<br />:01
<br />OTHER
<br />SIGNIFICANT CONDrtIONS Cowman conetunggto tem dean bur NI∎etalc, , PART 1u 6 FEMALE WAS THERE A
<br />PART
<br />A DS D, hu()er -Aens l'on, T nl ure/a ■ di ' ease PO 14344CY IN TH000.21
<br />L 'Apes •0 5q, 050 fl 00 I
<br />76 AUTOPSY
<br />i
<br />YP .S ❑ o M 1
<br />WAS ,,ASE REFERRED TO MEDICAL
<br />1 F TWIT:, la OR C...ONER'
<br />Yes U NO
<br />208 ' 1 265 DATE OF INJURY , (lay Y.) 1 26, HOUR OF INJURY ' 2En 005(3100 HOW INJURY O(;1URRED
<br />R AccdeAl U Urwele r. I
<br />T- M
<br />L (' J '' � iw C 1 26e
<br />,de POrunC 10.1005 AT WORtc T 251 + 1* C JF INJ�!RY Ar 1'5.00 .,- <. .a ,.a: leceav , Mg LOCATION STREET 4 R F 0 NO 1 . 301041, SPAT!.
<br />HOe .,,,lnn I 5 tie b E wld.n M: S OeC JN
<br />l _.„on„,,,„„ „on„,,,„„ ,. 1 566 ❑ NO ❑
<br />1
<br />27a DATE OF DEATH •AM Da, v.,
<br />261' ;)ATE SGNED ,MO Dal 0• - At 'rME OF CEA ;
<br />June 10, 2003
<br />i 275 DATE SIGNED (Mb Dav n r 27 TIME OF DEATH M
<br />j - 2& "'N JNOUNCFO OF Al, A4 • ()1'1. v :Ad PR;JN. (,. -5 1 -
<br />x L2 12 ; 17:45
<br />e � to t1'p Deg d my 0 ' n6 ned can °:ace and nue .,. Ma
<br />Causes Stated 9e b me 51'35 of elan Ann m :nvesuoat•:r n my on lawn , r cored a•
<br />^ c I IS nature and Um ! / '• analme one ime:
<br />m, , ••••e nate and Mare an. 1„1 to ale rau.e s slate
<br />29 DID TOBACCO USE CONTRIBUTE ^SATH. l'
<br />T
<br />■1' YES CI NO UNKNOWN
<br />31 NAME AND ADDRESS OF CERTIFIER 'PHYSICIAN.
<br />30311030RCsAN OR t1 '1AT1ON Rif N CONSIOEREU' ' 30h WA: CONSENT (.RANTED'
<br />1 ❑ , ❑
<br />YES (� N;, vE5 N;:
<br />CORONER 5 PHYSICIAN OR COUNTY a7T014001 hoop. P. - r - ' --'— Steve Husen M.D. 2116 W. Faiilley Ave., Grand Island, NE 68803
<br />32a REGISTRAR
<br />'
<br />1� fg% . 1/7 )ATE FII.E0 5Y'
<br />��((��.�
<br /><.c J �1N
<br />(S M Da, Y, :
<br />o
<br />� TRAP n 211n1
<br />17
<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT, ,OF,H At;TH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY 47 THE QRIGINAL RE D ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND NUMAN. SERVICES `. lima,. sPE EZ . F
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. , • j
<br />DATE OF ISSUANCE 2014
<br />JAN
<br />07
<br />Cruz % /(TAI CT ATteTIr' s I,Ar ■ I. s.
<br />201400338
<br />SFANLEA. - � PER
<br />ASSISTANT STATE
<br />” P RTMENT qF NEAL71-1 AND LINCOLN, NEBRASKA JAI SERVICE '
<br />)3 :06'952
<br />STATE OF NEBRASKA. DEPARTMENT OF HEALTH AND HUMAN SERVICES FINANCE A S
<br />VITAL STATISTICS
<br />CERTIFICATE OF DEATIh
<br />
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