201403986 - Laserfiche WebLink

Browse

1 DECEDENT - NAME FIRST MOLE LAST Earle Howard Karla 2 SEX ' 3 DATE OF DEATH Womb O.y Yawl Male I, May 15, 1999 UNDER 1 DA F. DATE 1C GIRTH Mx* OM YAW AND e- CITY D STATE OF WITH (PAWn USA. AMA Ca+aey) Grand Island. Nebraska Sa. AGE - Last Bilk* "N' 79 UNDER 1 YEAR DAYS 5e HOURS M 4$ 1 May 24, 1919 7 SOCIAL SECURTIY NUMBER - 507 -14 -2413 ea PLACE OF DEATH HOSPITAL LE MOM.* OTHER ❑ Nursing Home lib FACILITY - Name PisasaMJ9N Ow WNW and rew6Rw/ - St. Francis Medical Center 11 ❑ ER O.AFeOwa ❑ Res.oencr DUA ❑ oa..riSaWA. & Cm. TOWN OR LOCATION OF DEATH SP Grand Island I INSIDE CRY TRAITS Yee [I No ❑ tie COUNTY OF DEATH Hall ea REST - STATE 9b COUNTY Nebraska Hall 9C. CITY. TOWN OR LOCATION CawFi sh Grand Island j >ie AND MAIBEP 03 O Iota 9e INSIDE car LIMITS vas tJ No ■ 10 RACE • Ma., Whet. Black. Amman MONA et.) lSowsto White 11. ANCESTRY lag. NWae. Max .Gamma et; ISPIRITl American 12 Ed MARRIED D WIDOWED 13 NA/AE OF SPOUSE Maas le pee WNW Lt7 r MARRED 1 I DIr7aCFD 1 Viola Tacie 1u. USUAL OCCUPATION /Give kind a work 4Yie aieinrast daar*ral NM anon 1,6554? Farmer i lb RIND OF BUSINESS INDUSTRY 1 15 EDUCATION IS5ucb MN MON Es conwNq Between or Saaaawn 10-121 COHN (11a S -1 Agriculture 12 16 FATHER -NAME FIRST MIDDLE T John Karla 1 910111ER FIRST MIDDLE MINDEN SUMNIE Nodine Queeette 19. WAS DECEASED (Yes. M. r Ink) Yes EVER N U.S AWED FORCES? AFL 1 NFOtWNT - I yea Sae war ana MYM of esmiseel �2 -19 -1941. 2a NAME World War II B•- E -_ :�_ V'ol- = 1- (C) WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMEKT.bl HEACTHI AND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE O1 IGINAL n RECoRD FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES; VITAL RECO12DS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. •. ,TA OOPER ASSISTANT STATE REGIVRAR DEPART NT OF HEALTH AND' HUMAN §Cs ICES, DATE OF ISSUANCE JUN 2 4 2014 LINCOLN, NEBRASKA DUE TO. OR AS A CONSEOUENCE OF STATE OF NEBRASKA 201403986 STATE OFI DFlARIMENTOFOFVITALTA AND HUMAN SERVICES FDANCEAND•SU�RIORT ONS CERTIFICATE OF DEATH 05948 (STREET q1 R.f D 140. CITY OR TOWN. STATE. 2UPI 4905 West Old Po h, Grand Island, Nebraska 68803 N 216 METHOD OF DISPOSITION 21b DATE ' 21c CEMETERY OR CPFw1ORY MIME 4Fd 1071 � , ; a , ❑ „, 5/19/1999 j Grand Island City Cemetery CREMA•ORY:ACATION 'i C:� TR TOWN STATE Funeral ' HOME - E 216 CEMETERY OR ❑ 1a.•, ❑ D Home 220 FUNERAL NOME ADDRESS (STREET OR R.F.D. NO CITY OR TOWN. STATE. 21P) PAA7 OTHER SIGNIFICANT CONDITIONS • Commons amenbr irq W We Me1A but me maws L Grand Island. Nebraska 1123 West Second Street, Grand Island, Nebraska 68801 -5899 PART *MEDIATE CAUSE / • IENTE ONLY ONE CAUSE PER UNE 505 669. w a DUE TO. OR AS A Yawner ee•see•s• A NUM. Wan.• 9eYeese •r are 6600 Wawa. aeawwew ewer EMO eww j PART M K FEMALE WAS ( i ' N ' E � RE A ` M AUTOPSY l 25 WA$ CASE ,EI9.® I TO MBOCML PREGNANCY I N es El THERE ❑ / tas 0 N. - EXAMM wo 26. 2Ib DATE OF INJURY Pao. Day.. YW1 26a MFJUR of IMOURY 1 2Oe. DESCRIOF NOW I:RRY I O(CUrwtED (L�T— INJU ❑ Amara ❑ UMMwmnN6 ❑ Sat.M ❑ Penang Ma *MUM AT WORK ' 2a. PLACE T INJURY AM Mn weer fatarr 2a. LO"i.ATtON 57REFT oa a 0 D NO I I a�Fw a"MRi ea; ❑ 14..041 InM r• YIN ❑ Na ❑ , 21a DATE OF DEATH AM. Oar Y 2a. DAZE SKMNEO a/o Dow .1 , cM: r0RTOMP. STATE 200 TeA OF DEATH l i 4-- 27c THE OF DEATH 2tk PRCNO)$dCE0 DEAD Mb C91 Y. ; 202 PRONOUNCED DEAD Palo a l - ,?301 3 M " g g e.0..... Its s 2h 0" me Mrs 4 ~unman M211.!AwM.16. nw, W..' IM' eaw.ee• ,.. o 1ne 1..w. SIN •.a pace .+.r hue M 111 reu1M? 650 �546WlevC Ta1el' , A O TOBACCO USE CON u 0.. TRIBUTE 10 DEATH? � 3 *MS warn OR TISSUE DONATION SEEN CONSIDERFU'• 3a .0 W A 1 5 CONSENT AMOED: I F1 YES ❑ No �yNtMgWN 1 ❑ YES NAA 1 ❑ YES El.C— i L7 7/ AE AND ADOAE9b OF CERTf�1 1PH1'SICIAIN. CORpNER'$ PHYSICIAN OR COUNTY ATTORWEYI - ilpe o Prot I Dr. Gordon 3. Hrnicek, 729 North Custe , Grand Island, Nebraska 68803 A= w 32s AEGISTReR 720 DATE FeLL•D ri REGIS MAP MAY � 4 M M