... .. _ . _... .,
<br /> •a.Fn :.tiw►+n+aa��nt�.�n.r... ,.(
<br /> , . .��.,r:.....w..�..+tdti..� �• _
<br /> Ya,.�' ,...a.��.,... .'• ' � � f,`�.`��_:�_.. � ---
<br /> :.,�u..�,:..a`��:�.i.;n:,.,,�:�—�" . - --- -- -----� —'��'�`���Y t,:Jr�r''=��,.-�_��---�
<br /> ...� ��..,._�l.�..�._.�Y..1...- .'_��:.._..N-'— --'.
<br /> ----__. ._ _... _.. ._..__....--�---- --------•- _...
<br /> .__ . ..... _.__.._ .. . .
<br /> � 4 /D�� �� �
<br /> �:��� /)1�''` '- /�D I t� �TAt!O NR/11A{KA-QE�Al11MLNT 0�H[ALTH QQ� ��/��
<br /> K.�--_ �UIIlAU 0'VITAL�TA7I�TIC� 7 V �hl�fil
<br /> , ��'`'�`��C. CEPTIFICAT� OF DEATH "'•""'^'�
<br /> �-_____.... ��-----------•�-�--�xiT-'- r M■ a iM�ea �Hiw,n ow�w�
<br /> 1 PlHI�W.1/6
<br /> . �arle 6vnreLt Hrirt•�n Mele�Decen►ber l 19,Q,5_. `
<br /> � iF'v�"io�Li�ii�iii,��w u �M+qtw�Y/� � 11M11111 vfF�A� UM�INI WY •�iEor r�u� ��••��
<br /> `�"��w iu1� i W�'_"--_---'
<br /> �Yp� y,IMjp r� ai MoIM�
<br /> �v I ' 82�� ��_Qec�ml�,.er 1f�,1�,..12
<br /> Wood River Nehreeke _.., ._...1 M%ACA W U�Atll
<br /> �{ Of1�lMCU1;f/�i1 HIHfIIK � ►M�M� OIHEN � IM►+7�M�
<br /> 506-01-8909 � cnaMw�+ �}7�'r�
<br />� MIM.l11Y.NMM I/fWN.rn�,v��n-)I)!N MI���� � O -. - � _.
<br /> �� ONM I?O.�hi
<br /> 309 Mein St b.,�air4.■�n iM GQN1rOi OG�M '�""�
<br /> [IIY 70WIIC1ILOC�IIONpO[AIH � '
<br /> Wood River �" N0❑ H�11
<br /> � M 11ElU[MC!•lt�tE � R COUNtv
<br /> KG1r.�ONMd�lOCA1qN M6TnlLTNqMU►�F� l�►a'r1M�►I !�MlqEG1VlM�t�
<br /> li.� Nebraeka Ha�ll M in St 6 8 Y" —
<br /> W O R v L'����� O Moo�co u wwc os erouse aw.r+�+�wv�
<br /> Wi0 w�CE•N�.YnM OuN Mr«nw�n ��u+Cestnrlrv wnw.K�n.arnw��rJ —_
<br /> "c11°"`'^ ��M Sn lieh-Ir1 h "E�" °"O�LO EleanQr Bpld
<br /> W � White �b NNaaair,�eeNOUSrnr n Eoiic�na+ �ea«Me ti �r wwro�.
<br /> w IN USUALOCCUrAIION lG�+r1MN+aYA}MA�'`W� EMnw+MY0�6uo�Mr►p-�tl � CaMMI1.1a5•1 —
<br /> J
<br /> p dNauyMan+n�HrM W W kin 12
<br /> • � � Cdr @tlt L' wac ��si �� wr�� sias� r,�oo�e ►wxMe��wwrc
<br /> W � 1�fA1NE�•W1ME F�7 BO.y'�7
<br /> � !P
<br /> V 1/a Mf01�MNT•NA4E
<br />_ Z O • It W�!OE�CEAfEO EVEA M U! MN�ED FOAC(�i —
<br /> � � �Y�arowurrl IIY�sO�+wrMtlMnNwMaN
<br /> � M IA���T y�Mp�pq�5y 15111EET011RFPNO.piYplTpYH-STATEAI
<br /> � b
<br /> .� ,g, Main .Ci ��� 21a�E��O�qY�'�T� Zlb.W7E !IC CEwE1E11YOHGEWiORY NAME
<br /> 7P Eruusw.010N�lUff�lICE116EN0
<br />�- �E ' ��� � ❑��r �10 CEMETERY q1 CRf�N1p1Y IOCATION CIIY ON 7pW/1 ATE
<br /> W Y7�i lIO�E•
<br /> � w � ❑G�"rm Q Oo��
<br /> u
<br /> Q L �y i µl�p14 App11E55 1lTREE7 p1 RF D MO.C�P(OR tOMM.9t�TF.ZiPI
<br /> 0. 1 YM'v�0��.�M�arM m's M�n
<br /> � O � � 1AMEOMIECWSE IENIERONLYONEGUSE7ERLf1Ef011u1M.�IcN I UNKNOWN
<br /> ' ' W � '"" CARDIAC ARREST , �,,,,,,,,,,M,,,,e,,,,,.,,,,,..,—
<br /> � �
<br /> 'r LL ' ��:a.,......�L..:._..rwx r,� �
<br /> ' Z �
<br /> ' �j � 1 MNMIMIMMawIMdNM�
<br /> DUE 70.di 11!11 COMSEOVENCE OF �
<br /> I
<br /> 1
<br /> kl PMTM�FiEM/J£W�9THERE� N �UIOPSV t7 W�SG3EPEiNf40tO�dCI1
<br /> , �MtOTHEPYd�F�CANTCOHQTqNS•COMbM�mFO'M'MbM01M�bu1nalhlWE ►1�6HAHCYMiHEMST,WMiNl� E%M�MIEROI�C��pt
<br /> • � PHOS7RATE CANCER ,w.�o_s�i Y« ❑ "° `'« �"°—� �" �—"°—�" _
<br /> � PEh WtE OF NA1R� N1�Dq'✓�1 76t�qUf10i MJMY 7M.OE9CNqE HOw NAI�'�OCCU�MEO .
<br /> ! � AtetlMM ❑ �"'i� M
<br /> � �y� � Wnyy 7M k/JUNVIITMVN� 7E� �����.IIT-IrMlMobti ?rFL0U71ON �TII[E�011HFAND. GiY0�T01N1 �il1tE
<br /> � � YM�^ YM� MO� _
<br /> ?M CAIE 6�OM[D IMi.DM nl 7A��a OFAIN
<br /> � 2)�DAtE OF OEATN Ab.Oq'vi1 �
<br /> . e s
<br /> ��F / -g- � �.3�. B. �
<br /> ��� :�e w�esqnco n�o-ow��i e�c n+caoutH � »c vnae�ouxecoo�w nw ar.wl �nuMa+iaoow srv�
<br /> � $ F �d 12-7-95 8:55 e.,,
<br /> V 1 y�� M n
<br /> i • �� t7dl0weWMdm1���U1M�KMnAMMNr.AM�YNO��YddMbM 'lMO�MU�IYIrMM�MM�W'O �! • f5e�•h
<br /> b MFM.MIWI��rM �...«�f�N 7
<br /> � cM1�MN MM10. 1 Y/i�
<br /> ...Lyywn✓�e irN►
<br /> � t�d070lACf.'OUSEGOM�P�UUTETOiHE0FA1N1 �O�HA9U110Af10H�5SUE0pM1R7MlElNCpIM0E1�Ot Y W11SC01M�EO vElD � �
<br /> , � vE9 � NO � UNlNOWM � YE! � � .
<br /> 71 NA►IEAIA�OQ�E530�GERTfE/11M1YlCMMCd�ONE116r11YdCMNO�COUNIYATIO�NEY1 I�pOPei1
<br /> � DEPUtY JON RATH HALL COUNTY SHERIFF'S DEPT. GRAND ISLA�NDTEFNo�,��80�:1��,n�
<br /> u.ncos,�+n
<br />_
<br /> FOR VITAL 5TATISTICS USE ONLY
<br />_ � Place.......................A................................B................................C................................D................................E................................Part II.............,......:.TCenaus Tracl.No.
<br />— NSC..............................................................................................................................................................................................................................................
<br />_ ..............................................................................
<br />= Work....................................................................................................................................................................
<br />� .......................................�.
<br />,_
<br />— UC...............................................................................................................................................................................................................
<br />_ ................................................................................................................ ..
<br /> — Re�ect......................................................................................................................
<br />"' �nww.x�»r w M r.swr+w�� �..
<br />.� �__.--....��-....,....-.�.a,.�.�=.v-
<br /> ---_-- ' ...�.�r--�^.......�.�_.-._.-.-...�..... , �--•-..�' �� .v:.�s.l.>:'i`-- - -' :� �r .'=_',yn � � �-
<br /> . �. . . ..�.cL�,t,' . , . _�.. i .;�. -_
<br /> _.... . .
<br /> - •' � •
<br /> r - � .�71 � • -
<br /> y
<br /> _ .. �. ... . �� �,. .. , . �� ::� ��s
<br /> _, " ___. _. _ . ._._ __ -........ . .. ....._.. ..____"_"_ _,_'._'__ __`___.__ "._i = _ _"__. `_ ,'_._ . ."_."' .. -,. _ .
<br /> , . -- - � T:- _
<br /> � . _ ,� . .. t... . ' _ . ,: _,S'
<br /> � � , ' ' � .. � .. • . . .
<br /> ) r+ "
<br /> 1
<br /> � � _ . _. .. �._� __ .. . . . -
<br />
|