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t DECEDENT - NAME . .FIRST 'POOLE LAST Alien F. Schmahl 2 SEX Male I 3 DATE OF DEATH •M*1Yn Oar yam March 27, 1996 ' - 4. PTV AND STATE OF 501 or nan U rYma *WPM Norfolk, Nebraska Se AGE - LAM Balday (Yn .l 70 UNDER 1 YEAR UNDER 1 DAY 6. DATE OF BIRTH Month Day rare November 05, 1925 SO MOS 1 DAYS s, HOURS MNS 7 SOCIAL SECURITY NUMBER 504-24 -2398 N. PLACE OF DEATH 'HosPlul: ❑ ►,ay«. OTHER ❑ NwmLg Hare ❑ ER OWbrera ❑ 00A g] ■ Ras.cena /I Oran SarcM b. FACILITY • Name MAW nMaaK pm am rd matey Home: 2313 W. Louise TSc CITY TOM on LOCATION OF DEATH 1 id INSIDE art LBWS e. COUNTY of DEATH - Grand island 1 Yen 7 NO • Hail K RESIDENCE • STATE Nebraska ,0 . , - mo.. W M, Baca. Nasm n Indan bed Isoem om White - -- 90 CO Hall MTY 11. ANCESTRY a d.. lam MaacK meson I American _ 9e. CITY. TOWN OR LOCATION Grand Island OamSA Mel ,2„ MARgED ID 90 STREET AND NUMBER ancwdp Zo Coal 1 91 INSIDE CRY La6Ts 2313 W. Louise, 68803 vest] w ■ in WIDOWED 13 NAME OF SPOUSE la,wM � meow, . /was, C1 DRroRCEO � Iris (Vicki) Rath 14. USUAL OCCUPATION row WOW we Wow dons most of maim ly 4 t Ma1lnRaleL4 Manaa�i na Editor ,a a *Yisa _ aauc siolt .rn,. I IN.IONDOR BUSINESS WOUSTRY 1 1 Newspaper .... .._ ..— ____ is EDUCATION /Spada may amhym ram x a eOaery Ia,EI +•I EN 4'(`Y' S `oIs 1, a 0 265 9 lad a WM& THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF AN ORIGINAL RECORD QNfILE WITH THE STATE DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS WHICH IS THE LEGAL DEP_OSITQRY -ki VITAL RECORDS. 2014044"14 DATE OF ISSUANCE LINCOLN, 1 11EBRAS0 96 Adolf is WAS DECEASED EVER NUS ARMED FORCES? 07,/19n (rla no.a4aad MS. p.m mor a0dalmdaMeaM4 Yes 1 World War II 09/28!1945 ❑ AmaOW ❑ UMAIMax 0 ❑ sand' ❑ P«w'w ❑ H*1nit4da rwealwndn ❑ YES Bd DUE TO. OR ASA CONSEQUENCE CF' 27a DATE OF DEATH No . OW 7,.) NO 201. *QUIP, AT WON( s0 No 22a FUNERAL mow - NAME Funeral Home DUETO.oR AS A 00NsE0UENCE OF - T IN - PART OTHER SIGNIFICANT COMMONS - Cmdaaa ear(bua,g M the deals as mimed ed 200 DATE OF KUTY (461. Ow WI h � 2T0 DATE Day 27e TIME OF DEATH - 3' f 9 YN A 3o r? 27 0 . TO 0M my OOOWSOpf. d15o1(�Ccurrl0 M 414 0514 M Mace 1140 d a l° IM C51YMflersd \ �. • (Swan and Tam ► I 29 010 TOBACCO USE CONTRIBUTE Tp HE DEA UNKNOWN STATE OF NEBRASKA — DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH #1212 STAN S." CO - ASSISTANT STATE 'iE aiBTR$ R NEBRASKA DEPARTMENT OF WITH Schmahl 26c. NOVICE INJURY M ❑ YES 19a WOORMANT - NAME Vicki Schmahl MO NRORMANT MUMS ADDRESS (STREET OR R.F.D. NO.. DRY co TOWN. STATE Eel 2313 W. Louise, Grand Island, Nebraska 68803 cri kaft QF, ANY / N n01 t tern"" 1e2py 31 NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, CORONERS PHYSICIAN OR COUNTY ATTORNEYS nape or Prowl aNO Ida Dr. Gordon J. Hrnicek, 729 N Custer, Grand Island, Nebraska 68803 32a REGISTRAR 220. FUNERAL HOME ADDRESS (STREET OR RF.D. ND, CITY OR TOWN. STATE, am 1123 West Second Grand Island, N ebraska, 68801 -5899 23 WBAEOIAiE CALVE PMT ,`! /1 (ENTER ONLY ONE CAUSE PER UNE FOR 181. (DI. AND Icfl 21a METNOODF OMP0STION g7 a ❑ ❑Goad= ❑Denman, 216 DATE 03/30/1996 210. CEMETERY OR CREMATORY Grand Island, Neb PART B 1F FEMALE WAS THEE A PREGNANCY W THE PAST � 3 MONTHS? IAQ01110-54 Y1 I I 140 n Y1 260 DESCRIBE HOW INJURY OCCURRED Ala HAS ORGAN OR TISSUE DONATON BEEN CONSIDERED E 21e. CEMETERY OR CREMATORY.- NAME Grand Island (�ity C $tery A TION C7T MOWN STATE raska �`NN 24 . AUTOPSY MAIDENiBtYWA1E . Flock 320 DATE FRED Br 113 /M0. Day re 1996 30.* WAS CONSENT GRANTED ❑ YES r RA15EDZ SEAL � 26a. On av Deno al aflnanason and 01 nvaamgaton. n my mown MO OCC Wr1d M 814 aM. ale and dace and Due ID am CW7as. maw Owosso and 144) ► *woo 0naeen saw and omen Iron* 2— a rn5rr11011we1n *1411 and BOMB 25. WAS CASE REFERRED TO MEDICAL lJ//'E AMINER OR CORONER I✓1 Y1 fl 4I0 269 LOCATION STREET OARED NO CITY OR TOWN STATE 2M DATE SIGNED IM Day. Y r ) , 260 TIME OF DEATH M 26t PRONOUNCED DEAD /M0 Day. YrI 1 44 260. PRONOUNCED DEAD (Moan M