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<br /> STATE OF NEBRASKA-DEPARTMENT OF IIEAUTII •
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<br /> Bureau of VIEW St:Antics Y
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<br /> (� J CERTIFICATE OF DEATH. _ •
<br /> 6� ATIT 1
<br /> ! p .11 110 ND.H.
<br /> (CEASE.-NAME Nrlr .'DDH III, SEE DATE Of DEATH I14o14 TT 0.1
<br /> John Walton Finwail E ilale 1 Novrnbec 17 196
<br /> PACE 1.E 10000.A.IHC.N INDI AGE-1. V14 14 01 A. DATE Of BIRTH,VANE, D.., COUNTY Of DEATTI
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<br /> I INCL"1 ' 111.04'-1,11 .?...1..
<br /> -NOR 0.411 MVOO '1.111 _
<br /> Whi to ,. 70 EE DI .H I FTebr. 20, 11.19). Hall
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<br /> OTT,TOWN,OR LOCATION Of DEATH ot<,ty twin lt a 140 HOSPITAL OR OTHER INSTITUTION--NAME Ill nor IH 11m..0m 1'HI'..D Hu.H.1
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<br /> Grtu:d Island ,I Yes rI St. Francis Hospital - -
<br /> TATE Of BIRTH 1111 110,IN U 4..
<br /> l.A, E CITIIEN Of WHAT COUNTRY MARRIED NEVER MARRIED, SURVIVING SPOUSE 1 I w I1 1141 14110 N.V11
<br /> SOUNIHI WIDOWED.DIVORCED,Mom I '
<br /> E. Sweden 1. USA II `„krriecl_ I,I _iorathy Ellen._(i•;_o1.4_111nRAlL
<br /> SOCIAL OCIAL aUSUAL CICCUPATION 10141 11ND 00 WOOL DOHS 0(0100 14014 or KIND Of BUSINESS OR INDUSTRY
<br /> 4.00.1.41,V1,Tvin 111 110lln I
<br /> Ai 504-�2-8150 ITT I,aticrev 141. Twin ilVOI'S -
<br /> SESIDENCE-STATE COUNTY CITY.TOWN,OR LOCATION In Dl on 1414141 TIMI AND NUMBER
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<br /> -,Nebraska 11B Hall II,. Grand Island INYeo IN 323 East Hr.1l Stcaet
<br /> ,FATTIER-NAME Nnt .wo,, 1111 MOTHER-MAIDEN NAME loll .,DOH 1.11 - .
<br /> '11 John F inw:zll Sr. is .Tohaxa:a l'errson
<br /> INFORMANT-NAME-RELATIONSHIP MAILING ADDRESS 1 Un11 O.1.11 D.NO.VII OE 10w.,1n.H,IDI •
<br /> It. Ers. Doroth'. Finwall - Saoase In 32' Hast lIall St. Grand Iul an,1 1:ebr. 00001
<br /> PART I. DEATH WAS CAUSED BY: LEN/IR ONLY ONE CAUSE SIR EINE EOR(D),1111.AND 1111 111140110.401
<br /> ,Ai11.110 111414
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<br /> 011 CTE CON 1-t d..� (e. .. (,.T_• /A() // tri :..iLt.6,.4 L"_(Lsv..: S N "EINOH !L' _
<br /> PART I OTHER SIGNIFICANT CONDITIONS:CONDITIONS CONI!DOTING ID DEATH BUT NOT ALlA1fO 11!111 II YEMAIE AS SNL RIA l I 1 iV If RE' 1111 V1 ONE
<br />•:TO CAUSE RIVEN IN PART Rol 1111ONANCT IN THE PAST S MONIHSI 11.T, co " 1011111411411.0 CAULS
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<br /> YE1 t; NO IT.'1 lroD _----
<br /> ACCIDENT,SUICIDE,HOMICIDE, .A 11F INIUAY 1Nont,DA' l..' HOUR HOW INJURY OCCURRED 1111TH'0INUIT 011 1411 EI ry 11.40IOPE1N 01 IR1 ,
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<br /> OR UNDETERMINED 11011011. .
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<br /> INJURY AI WORK PLACE OfINJURY 411040,/MIN,111111,r.00E,, LOCATION 1114TH OR 0 ID.NO,<n OE 1014N,.111
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<br /> r'I I141114 111 OI 1101- 011111 NOG.111..111K0111
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<br /> CERTIYCATION- Vol.,, D.I rl.. .O. 1.1 TIRE •/all M010/010110,VIEW TNI DEATH OCCURPID LIMI 1441,,ON TNI
<br /> ENTSICIIN.1.D.e r1.. 10 / 100�V". w No.r /.0 I01.4 NN�.1 I ,nou.I /7� o�.T�Nwi.HD11/11.11
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<br /> TI ICS. 11110•.11 •- / '` 411.4 / t'C Ti 0` /7-6 TIE A!l<'1My 71. 0 h M. ml E.01411I11400
<br /> CERIIIITIIpN.-MEO At IAAMINER OR CORONER o,.1n.I.0. r TNI n 01 011 DIME 11.1 .I rlonuuHclo DUD -�-
<br /> 1 HW Ol TOT 1011 A.0/011 Ill11.141100•00. T 01000« 0 01.1414 On IOW 14000
<br /> DI 00.0210 O.MI 0411 1.01 DUI 1V 1.1.10110:1 'ID.
<br /> h M 1771 t_1 _ -- 1
<br /> l 1101 HE, ATE SIGNLU 1.0!1.0,HA.I
<br /> CfRI 1�fIfR NAME 1011 O.P1001-�_���---� SIGNATURE. J '
<br /> n C Dean EITHII th 1 ll 141 �_ C, ,e,.l �/ ,_t,j.1j-. /� /45CJAu1 //-/f- inL
<br /> MAIIING ADDRESS-CERT:ILIR OR < RIHE
<br /> 'Tu 1-C.1 '.1,20,DS,z-uon. Sts Cz_,1.d J r .14.1, NQIIra•e.::. 600101
<br /> BURIAL.CREMATION,REMOVAL CEMETERY OR CREMATORY-NAME LOCATION Nn OE IOW. 1411
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<br /> :In Burial ILL Calvary - Tdicrm NUtl_ , Grand Ir•land, 1eor,zrohL_ ^- - -
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<br /> DATE 0.01144 DAr I.. EUNERAt-11OME 'NAMB AND ADDRESS f r 11 0•lows,11411,1 r r
<br /> 7u. 1I0V. 2 �196C111 HT S'V 011FTdr-,nndF'r:1 11 ID.11L(E 4).1\C`.Cnif G7•cuid IQIEtnd GCL1'. 001301
<br /> EMBA R-SIGNATURE 66 DCENSE NO P f17 • EGn.IRAR-510NA LURE - DATE MAIMED IT LOCM 010HTIIAR '
<br /> :'156./ q 7 }ly ?-• IFI
<br /> jy��i!'LC'G� J'/ -eL.% {y'Ert-s7w•.1 '.� �� (JIfC-C L. ru :C'C(/ %l'
<br /> • WHEN THIS !41 OP;YArCARRIES,.TIIE RAISED SEAL OF THE NEBRASKA •
<br /> STATE DEPARTMENT OF)II tL'TH, IT CERTIFIES THE ABOVE TO BE •
<br /> A TRUE COPY•,OF} ANOIt,GINAL RECORD ON FILE WITH THE STATE •
<br /> DEPARTMENT'Ol•.JIEA"7;JIlt+•BUREAU OF VITAL STATISTICS, WHICH '
<br /> IS THE LEGAV DE1'0l'�TORY FOR VITAL RECORDS. •
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<br /> DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
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<br /> LINCOLN, NEBRASKA Issued .January 2G, 1970 •
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