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<br /> � STATE OF NEBRASKA—DEPARTMENT UF HEALTH
<br /> - . 78�l1��.3�fl Burrau of Viul Statistie� r— .
<br /> r �j I.'r CERTIFICATE OF DEATH,t-�s:> � �
<br /> � 'DfCEASED—NAMf SER DATF Of DE�IN��owd,o
<br /> �. PHOEBE VII1�fp ELGHMY , Female � ppril 15� 1976e ' '
<br /> �RACE rw�n,�a14ro.�r�nt�w�we� , AGE—u>� DATE OF lINM�ww�w. COVNT�Of DfATN \ �
<br /> :�K. �fr cw�� u� •� rof.t w� rou� ..x� � •
<br /> . W�ite ,,��90• ,,� „~e .RNov. 23, '1885 ,. Adams
<br /> .CifV,TOM?�,OR IOCATION OF CEA1M uo NOS/ITAt pR OTNER INSTrtV710N—N�M �u.o��.�rt e cn�s�nt�..+o.ur�h�
<br /> . �r�<�r� •n ' .
<br /> n_ Hastin s ,, yes� � „ Mary Ianning Memorial Hospttal
<br /> ;STAiE Of�IRTII��r wo��.+u.f...,• r CITIZEN Of WNAT COVNTNY MAlIR1ED,NEVER MARRIFD, SURVIvwG SIOUSE����. �.Grve.u�oe�run�
<br /> couwn�� WIOOWED �IvOR ED�fretwri �
<br /> � linois + USA ,, Widowe�d „ None
<br /> �SOCIAI SEGV413T NUM6ER USVAI OCCU►I.TION�w or ro�a oo�.�ou��..c..ou o� KIND 01 WSINESS OR INDVSTPY �
<br /> . ..o.n.w u e,m..u o� . �
<br /> ��.507-60-801 ,,, Housewi£e��• C 0 „�. Domestic
<br /> �AESIDENCE—STATf COVMY ('f�Y,iOMTf,OR tOCA710N SiREt7.tMO Nf/MfLR
<br /> �...�Nebraska ,.� Adams ,,,. FIastings �,,,����yes��',,, j00 S. 'ist Ave.
<br /> ;fAfMER-NAME ���y� - ri00�1 ��s� MOTHER-M/.IDEN NAME r���� tirpp�� y�� .
<br /> is. John --- Lamps „�, Kathryn -- Lowenber�
<br /> ���WAS DECEASFG EVE�It�Ftl:�l.wRMED FOIlCf59 INFOItJM1VT—NwME—REIATlONSMI�—MwII�NG wDORE55 �� • .a •. •ro
<br /> �(���,ws,e.�wkwsw) {II y��,piw.e•ewd dar��al�.n:�.) ' .� �
<br /> no ------ ,,,Mrs. Edward L. Wilson(daughter)35�5Topeka St.Corp
<br /> �A�T�� DEATM WAS CAUSED!1'� �fNTFN ONIr ONf CwUSf VEY{WE�OR�o),Ib).�i+U(�J� � .
<br /> �. 1�. u�.uoic��t��f� � ��n. • .
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<br /> .:ie�u�<A�ie'e�o lef � � :.l o w.�irvl-+ T�.iGmy,v.-I L C.f.��Livl � �'�t�.�t..!..G•�C.:c.� �L(+ f � .
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<br /> �'r�n u. Oiw[t fiawnic�wr cpwDitioNs.Cd+o�no.+s[w+�n�unwc to oe�rn�ui Nor nuteo rwrt�u.�r re.wu.w.s tHF�t• �UiO►Sr if rE5•+ +as c
<br /> I ro c�usc crv[w ua r��r K.� necN�..cr u.��i��sr o roNrHsr u .� � one...�,.�„o c.�.�
<br /> � .es❑ wo[� i.. �f o iw.o,,.. .
<br /> � ACCIDENT.SVICIDE.FpMIC1OE. � INIU �ro ,o . ��• MOUQ MOW INIURT OCCUQiED�ew���w.����or i..i����w r.���e�r• . .
<br /> .'OR UNDE7E�MMED�anan� •� �•������
<br /> � �� 701 ]W M. ]W
<br /> � 1 s,neRri A�s w�0� �UCE OF IN)lMY��+Or1.�� .f��lf. K'�W. IOCATION i ff�eft..��r O.n0.Cin O�tOwr.f��tf� �
<br /> • � ONK�NC6,tK ���K�n�
<br /> � A�. AI. 20� � .
<br /> CERIRIU7ION— rWiM 0�� �i�� rOnm �� �t�� �� �"��+1���rl O+ �D�O/Di0 rOr n�r�n!Df�IM OCGU�RlD w .
<br /> �rwrs�a•.': TQ .. o �i.. .00.urt.ne.�r �p«.o..n.ey* .
<br /> r. o;�.:;>:o. G�h�/6. 7G �� �S•7� :„ —�5.7 6 ��. ,c� ��•�`s'�°�M ' :,�<'�u��;°o
<br /> CERTVIG110N—MEDKAI E%NAINER OR CORONEII�o.. . •r.� .o��or e. e .s n.o�wr.eeo o�.o �
<br /> IYrw��qr W m1 pOr.wo/o��w�Iw.ti�iG.�qr� r�Or o � f row� ~ y� .� ''� .
<br /> o„..«cvnro a..nu o.n..�o ow eo n.e c.u�ui�i+..ro. " J` 'ie iu.u�.o M1;C :�GG( • /,�' G v/•� . � �
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<br /> CFRTIfIfR—NAMF mn o���wt� [ SIGNAiV�E �o�m�e OwTE SIGNED i o��,�e�� � �
<br /> t�.. `' � ll¢ rs �t,yG1_ �� p�c.A 1h � ' 6'/M � .
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<br /> MAlIMG ADORE55—(EfilfHR o��.r o.�+o -<� o��o.+ y�� ,� '
<br /> 1L. � • f i'�et ��rv �r�.l�
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<br /> ��1�.V.EMATION,REMOVAt CFMETER'f OM REMATORT—NIw�E t CAiION e�n e��p�+w a���e
<br /> ,... Burial „� Kenesaw Cemetery ,,, Kenesaw, Nebraska
<br /> DAT[� I.Ovrn,w� (� � iUNE�AI MOME-NI.ME AND AOORFSS �
<br /> T.. Apri1 19e ��'7S rs,;Jackson Eltneral Home�,���Kenesaw,��Nebraska����Y8956
<br /> EMlAI/A[R—SlGNA7URf L IICFNSE NO'� - REGI RAR—SIGHwIUNE /l . o�re�ecer.eo�.aa•a�ee�sr�.�
<br /> ` 76° " ��.1[u,L��z�/.i��`li�"�u2� 71• APft 2 2 t976
<br /> � • ° �390
<br /> ��.�'�`�:����� �:,
<br /> •-,S,THEDI,'��tS.'CQPSt C � �tIES THE RAISED SEAL OF THE NEBRASKA
<br /> STATE �PAibTM� �; �-:HEALTA, IT CERTIFIES THE ABOVE TO BE
<br /> A TRU•. '?'y�,OP1� 0 ���RIGINAL RECORD ON FILE WITH THE STATE
<br /> DEPAF�E"iJT,.�F�' �c�I.'�H, BUREAU OF VITAL STATISTICS, WHZCH
<br /> IS THE7����� n �E $ITORY FOR VITAL RECORDS.
<br /> ; -����,
<br /> } �`��` �'.�.�� �.'�
<br /> DIRECTOR OF VITAL STATISTICS ANB ASSZSTANT STATE REGISTRAR
<br /> LINCOLN, NEBRASKA Issued May 10, 197G
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