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<br /> � �7 Q • STATE OF IVEBRASKA—DEPARTMEM'OF tiEALTH � . .
<br /> . J�+_ �Q 2 2�.7 Bua'eaa of Vital Statbde� �— —� � � �
<br /> nN+�N' 1t361/12 CERTIFICA7E OF DEATH .�¢p ,..,,.,,,,.,,,,,,.
<br /> ,T IMR ��q� rwx� usr � DAtE Of DEATN �ro..n..o.r,.ew�i �
<br /> DKlASED—NAME . � .
<br /> ��s•�: l4ormeta Paul pehllce , Male , MaY 14, 1968
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<br /> MC!w+m.i+�oq.�.M�ur�Meur�. AGt-4�T ����R+� •�wr �TE Of 11RM��NM. ewt. COtJHfY Of OEATN . .�� .
<br /> � �:.� .;c. ianan� �i� ��mwr�rwss%roa. un .ans •••. �. Feb. �.�. Z �.'2 r�. fi82.�. . .
<br /> crtr. ow�+.o �oun of o�wn+ b ancu i�s o��Mo �SMAL OR OMER NSitfU71 N— AME�n wr iw a+Me+.crv�>rnn.rw..w.��.�
<br /> n. �r�,nd Island , Yes ,.. 2224 West 4th Street
<br /> �STATE Of lIRiM��r��.�o.�s...,....e cmzer os vmi.r cow+mr MARRIED,NEVEII MARWED, SURVIVMG SPOUSE�n+nn,arv�rwro�w wrt� .
<br /> ' cw�m� WtDOWFL.OIV'ORCED i�ntu�i .
<br /> `:�. .. Nebraska ,. IISA ia. Married n.Selma (KruBman Dahlke
<br /> Ko .SpCtAL SKVRfiY NUA1lER USUAL OCN►ATION Iaivs ias or wo�[oowe wtuq rosT o� KWD Of lUSINE55 OR INDUSTRY � ' � �
<br /> .M w�O�awO 11A.fVlM 1�hT�M 1 �
<br /> ;R �:. 508 10 2049 ��. Contraotor - �a�ater ,b. Buildin
<br /> RESIOENCE-57ATE COUNfY M'�,TOVIN,OR IOCATION ���o�Cm�uun STREET AND NVM ER .
<br /> 1 Me<�N�Is o�MOI ..
<br /> '� u.. ts �a. s �«.Grand Isl&.nd w Ye[3 �... 2224 Wes-E 4th Street
<br /> FATMER—NAMf r�nt , r�oou usi MOTMER—A4/DEN NAME rnu ..�oae ufr , �
<br /> �s. John H. Dahlke +�. Minnie Liedtice
<br /> INiORMANT—NwME—REtwifONSN/► 4v1tt�NG�cOORF55 �smrt o�r.r.e..ro..<rc.oe ro++»,sr.re.:r.i � � � ..
<br /> ,,.. = Wife �„. 222 Weat 4th Street, Grand Island,Nebr. 66801
<br /> ���. OfAT/wA5 CMJSED�Y. �FNIfR ONLY ONE GUSE�ER UNE FOR(o),(b),AND(c)J ��rvaer o �� � �
<br /> � �� wr�ou G�se �
<br /> 1 �� io� Acute �pocardial infarction �-
<br /> :„;<;"a;'t;;,^.;; �m Arterioselerotic heart disease 10 Years
<br /> L�.���.�.�'"�e::: � �.,o.o..:.<a�u�.�.a,
<br /> wO C�Vft Uft . .
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<br /> ►A!T 11. OTNl�SIONt�1GNT CONOITIOMS�CONOI1qMi CW�Tf�lYf�MO i0 DGiM�UT MO�RFIAitD �A�T NI.If/4Nll.WAS TM[RC A AViOrST IF Yi o w en��r�r,�pf COM. � �
<br /> ' TO GYSt 6P'EN tN tAlT N�/ 1�lOM�MCY M TM!�AST]MONTM31 1�[f w�� Oi DiwrN�ee 4uft
<br /> ♦es O w0 O N�. NO tri. '. . �
<br /> ' ACCIDEM.SVICIDE.HOM�CIDE. A �ror�in.w�.�e��� HOW INJURV OCCURRED�[rrte�wrv�e or�wlu��Iw��n�o���� . r�al ' � � . .
<br /> 00.VNDE7ERMMED�vK��� . .
<br /> 50�. ]Ol tOt M.101. . . '
<br /> INJURY A`T WOItK RAGE Of INAAtT��nor.���r.stnrt,rwcron. tp�Anqy �fn�n o�6r.o.wo..Pn o�Mww,sr�rt� � ' � ..
<br /> fiMOn so�Mo) qrKll4Ca..elC. lf'lCin1 � . .
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<br /> CERTIFIUi10N— ��M �� ��'� '��TM a� �ue �MD ua�Lw ww/we�A„M O+ e�o��Q���tW TMe DlwTN OCCURIIlD• �wt Nwtt,On n�t ' � �
<br /> ►wrs�uu+� ..o�.n. w• . :oe+•rn.oe•m. .w n..� •.e ro e�� . .
<br /> m..om iwe T� o•M�.r.o.�ueee,ew
<br /> ,,.. e.�,.,,,..,,,Never attende� t�._ before ��.. Did not a��. Did t�•.�� A M. o �•����*,��e. .
<br /> �E471/1U7iON—w�ED�l ExwM'NER�OR CORONER:o«n�e w.a or n.e wou�w n.n. �•e ea�eew��.0 r.o..w.c�o oue -
<br /> 'n��.no w�.�wiew.wu�oue�o n�si uus�eiii i�.no nwa... • iOg��.S A. , . ..
<br /> n; n�.m.Ma � �,• 1968 M.
<br /> CE1fi1RE[—NAME Ime o�rnwn . o�ene p rme� AtE�sI O�.b�TM.w��.ru�i , . .
<br /> n.. BBrtOn D. IIrbauer M. D. �� t Gsti , ., � c�.c-/ii�. »..//+ ?u._�/�a;f•
<br /> MARMfi AOORE55—QRi/IIER a�u r o��.r. un o� . . .
<br /> ,,�. 217� �ortgi�ine St., Grand�slend Nebras`�sa 6��01
<br /> . lWIAI,CNEMAT�ON,REMOVAI CFMETEi['/OR�pEMAiOR�—NAME LOCATION an o�rowr� S*�n � .
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<br /> �.,.: :o. Grand Island a... Grand Island Nebreaka
<br /> �j�� . I��N.y�.�L�� FUNERAL NOME—NA/ME ANC AOORESS 1 f��Itt O��.I.e.w0..Cir�O�io�vr�.fiwte.!ir� . � ' .
<br /> r.. b 16 � 8 . ri..I,i eton-Sondermann F.H. 0 West Koeniar Grand Is a N
<br /> �� EMSAVAER SIGNATU/�CQySP�2S MEGiSTRwp-5 wI RE o�r s� t �
<br /> ; ub��,��,J�i` ��k �ea9 �.. '��!=l���l-�l--�-L :,�.�/l��/.��/i%16�' :
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<br /> �'�I$IS CERTIFI�$,�IiE ABOVE TO BE A TRUE COPY OF AN ORIGIIJAL
<br /> ;*��7�ALTCOF��E STATIST CS, WH CH S THE LEGAL DEPOS TORY
<br /> ; FC�j2�7�TAL RE�ORDS.
<br /> . �,�n ".�'. . `<, ' Oi4re.eC�� ��
<br /> ; �"Ts �S,ti3���7 Y:�t { .
<br /> v�o � DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br /> i ,r^7�1���,? ��_ � � LINCOLN, NEBRASKA Issued May 24, 1968 ._
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