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( $TATE QE,NEBRASKA DEPARTMENT,OF HEALTH
<br /> 6..4 isIio. &tt0 �9 9$7973 " Bureau of.Vitd Statistics
<br /> 47rT'. > . CERTIFICATE OFs.DEATH / rf ,RT„IMwYNRN:
<br /> •ECEASED@9NAME. 4104.,: w1DON-. _.. fyr�:, 5U DATE-OF DEUN.t 004140,DAI/.411{4
<br /> s _ Robert Leo'.:'. Lester.:; 1 Male'.;: 3October.'5, 1973.
<br /> ACEw40It.01010,Aau.AN T owr, AGE t.s, -Y u `• smote DATE OF RmTH t*OOW;OAT,. COUNTY OF DEATH
<br /> FIC, IE KTrt1 ORTRw. u.3r NW N.
<br /> OW3 40, f
<br />�$$., White.. ,wgb' ,;.. 11 ��r�leb ':26, 1893 TL Hall.
<br /> Yam TOWN'OR LOCATION OF DEATH,• moot Orr two.-. HOSPITAL OR OTHER NSTITUTION-NAME IY NOT 1u IITITP,Ane VMS*NO OU011I,
<br /> JUN' .,. � 4,451 rt ni 01 n0,1 - -
<br />.D...: '+• - Grand'Island: ,';: Yes '.', H ,st.' Francis Hospital '
<br /> ZETATE:OOFBIM TU.mot in*.1.1:0"1*,OMEN OF..WHAT COUNTRY MARRIED,NEVER MARRIED, SURVIVING SPOUSE to wol,Anr,Mro01 oANR.
<br /> EOY mi: WI �'!LD'DRY P D is...,
<br />�+`��d1s5al�Rt`!-� USA.: H'4Earri�c�", N.Amelia (Sorensen) Lester''
<br />;SOCIAS SECURITY.HUMRER= USUAL OCCUPATIONTAne C40o or wow DOOR oWINA 0011 or• KIND OF.BUSINESS OR INDUSTRY
<br /> ' WouNq m<,evlN. uuDl''
<br />(77 506-09-7373A. , Livestock:buyer ,..1-.-!. 119. Livestock.auotion
<br /> RESIDENCE—STATE , - COUNTY- - CRE,TOWN,OR LOCATION::. 100101 0114 IA STREET AND NUMBER•
<br /> ,.': . If tcMr Tel
<br /> NOR .: ,
<br /> 71;:Nebraska:: NL. . Hall.. 1,,, Grand Island. ,,, 'es 1/., 2516 W. Charles St.
<br /> E ATHERNAME ow,' ol0Dte : 1111 MOTHER-MAIDEN NAME' r ': worm ' ' ust.. /
<br /> IsO.. JOPnl'7.: .G. Lester: Ioil,IS Martha, Carter,
<br /> 14•WAS DECEASED EVER 7N U.S.-ARMED FORCES?' IUIIONSHTP-MAILING ADDRESS -4111110R LLD.NO.,ON of Town, 101
<br /> EY„,to ..L.a..7 UY;:.,l»..,.odd.1.1.1nT.w.7r NFORMANT..NAME-RE,Firs.,Amelia Lester-Wife-.2516 W. Charles, Grand:Isl
<br /> PART 1 DEATH WAS CAUSED BY, - INTER ONtr ONS CAUSE PER LINE FOP(0),(II).AND IU) mw,iwINNAN ONTO AND Nom,
<br /> ledivAA
<br /> I�, 140"104"[1401 i,����� i�.,.�,�Q "� � / u'
<br /> E i �E� '� e '"_` c(Icy / i
<br /> 0::-.CD DITU 1 r J�7'I_'�_W /// /y//5� lm p
<br /> IDIAit<Y{1 �
<br /> i: DW fD,OeU CO OWNC!de.
<br /> 1 1YoIR- a ,
<br /> .. .C�/ NO TO DEATH
<br /> RUT H. .,WAS AUTOPSY IF TED Will r DIHES COW..
<br /> MRC US GIVE SIONIEKAAITK.4 CON DONS:COM'. COMRIRUITNG YO RUT X01 if W IAt111.R VEIN VIl WAS TNME A
<br />,TO CADS(ODI,"IN PAR K.1.-� PtfGNAHCY IN INR PAST 3 MONTHS! I TI 01 Vizir.t0 1N DIlMINING uYN-.•'
<br /> O D I
<br /> ACCIDENT"SUCDE;HOMICIDE, DATE OF INJURY.. HOUR HOW INJURY.OCCURRED r,...Aron or..1040 IN SART sow we,11.r11W no
<br />'OR UHDETIRMNED 4snbm
<br /> • 744. M.700. _ -
<br />...DORY AT WORK PLACE OF.WADE AI A.A.EA.,..ET,'AODC., LOCATION 1Sotn oe 1.r,D.No.,OTT OR TOWN,OASTI
<br /> TRPROf.,in of 005 - OM.I.DO..RTC.1,,0014
<br /> CEETRICATION- AONTO ow • •TSAR ( NONN - OAT 4111 AND*111 ww Nw/wt.AYv1 00 101e/oro NOT,NW ON DEATH OCCU,LLDAl lot STAG,.Ort ME
<br /> PN MA/Et TG 0AT5 TSAR TOOT AMSR a 1NW11 4R D.H.1..0.IO Mt RTO
<br /> :1 AMND{D TNR.` L/ d— �J�J / n ... or r1 CNDwOooi,oW
<br /> ?f '��0,40"0 nor �� ��� .O� 1711,/0'.r J �/ J 774./6--e--7g u!N�(jr� 71�...pM.10 Ne uWTnl saws.
<br /> 'CEKT94CATION-MEDK:AL EXAMINER OR CORONER:oN e..uO{or w. .UNI or 0,.40 INN 0"140 n0Nowoto RI..
<br /> RRMRNOIN r-r'YR ROOT ANO/oR we 0TNINM ON or 05 0,40101., NONNI DAT TSAR NOMI
<br /> 10IMH OMR.=oN TW DAN AMO ow TO,we ulna O surto::
<br /> M.III (��D1.�,(y�D_( M.
<br /> CtRT1FLER�-NAME Im a IMAM. SIGNAjtE /] /")�S`C�//„'I-".'rlOW_ DATE SIGNED I^y� D r,TUC.
<br /> p..C. De7an•MGrath la. D. 741. ►/d—/J/•(Jl..w.vJy�L `T// JRfAmC�jn. /O` b--73
<br /> KING ADDRESS-QRTRIER J,r.S.`.tf,'• 170µ'West"Second.'St., Gra11°a Island. 'lit.. 688b1
<br /> BURIAL,CRHMTION,.IJEAOYALAct CENTRE OR CREMATORY-NAME. LOCATION - On 04 IOWA, 1110
<br /> 74:. Burin Grand:Island (City) ;711: Grand.Island NE
<br /> DATE , F T 0A IA,T ;,7Uj 91AI'HONE-NAME AND ADDRESS I am..1.D.No.,On o.TOMO, WI
<br /> w:Oct./a 973E r. yinEsto Sondermann's,50 W.Koenig, Grand Island, PIE 68801
<br /> .:7111G11.4„74/11 R ER4seNOik,E2B, REGISTRAR-SIGNATURE // DATE Immo IT SOCar REDOTRARR
<br /> •%, F„ CJ ,7f"�: 74 , • E ii.1”' Ts•7///Y/n1L7 7f!
<br /> r,rT.rs .y3 t0,. - __._,.__ _-_._.._.�_- ._. •' :_.
<br /> z::, ..N- THE ABOVE TO BEA TRUE COPY OF AN ORIGINAL
<br /> K
<br /> ',C:±4: + CAE:ON'FILE.WITH THE-STATE DEPARTMENT'OF:HEALTH,
<br /> filU , `OF:VITAL.STATISTICS, WHICH IS THE LEGAL DEPOSITORY
<br /> FOR1:VITAL RECORDS.'
<br /> DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br /> LINCOLN, NEBRASKA,..: Issued November 14, 1973
<br />
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