201405923 - Laserfiche WebLink

Browse

STATE OF NEBRASKA WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF (-HEALTH AND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES; VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. !. CITY. TOWN OR LOCATION ( WWI) Arellano Nagle soh 7 SaADE. EnNEILS0 I 5 , ..• -:.. Swe1 - St MOI ' WS 56. HOURS 1 * .. - 75 ' 1! ril 20 BM .....ar HCENNTAL ❑ X10�IISN OT IM 0 StaNna wor, 0 ER OIIb Ae1A -,..„ .... 903 E. 5th St. ❑ oar► ❑ OM, Irma* T O W N OR L O C A T I O N n TM Grand Island S05 -26 -6357 NI RACE - leg• MOM Mack. Amman AAaa. American Grand Island Y lfq,. MWL Mama. O ,wN: st) . 1 lab KIND OF 61MINESS MOUSTRY 903 8. 5th St 68161 �+ ❑ WIDOWED IGMEOIIEFOOE'E Nt.w/ri*+r(6w.aw n DIVORCED Of i l i a Avila ' I5. EDUCATION IIMANN NW RalAINFOR ITHE 1 Samarery a B► 9.66nINF TFJ COM /1-4 ai 5•) F T MI6 M OI SURNMIE �1. -wus DATE OF ISSUANCE SEP 12 2014 LINCOLN, NEBRASKA MST David ETA ("MATH ,1F +YSf4, USA. lwaNUUry Wichita, Kansas FATAB!- NME FIRST FUNERAL PAT t je(2 t tAx 6- TO. OR AS A CONS OF a► MC k$ TTA i — '1 C tz. DUE TO. OR AS A CONSEQUENCE OG $T 1C OPER ASSIST TE RE ISTRAR DER MENT OF HEAJtrH AND HUMAN SERVICE STAISOPNIIIRASCME8 1111ad /011111 AN88RVICf6181111EA,18H CERTIFICATE OF DEATH Railroad LAST 117 MOTHER Thomas Arellano I Guadalure IS NIAS DECEASED EVER N U.S. AMMO FORCES? 1k. INFORMANT _ NAME Iris no. a u1E) a yin one tow and tap M NNW* Ho Ofilia Arellano Mb INFORMANT MACRO ADDRESS SWEET OR RF 3 NO.. CRY OR TOWN STATE. BPI 903 E. 5th St. Grand I$1and. Nebrsska 20. EMINATER -; TII OS E NO 21a METAL OFF0aii0N 7 -5 DATE Sic CEMETERY OR CREMATORY SAW D7/ I Ea ❑ a !Ma rch 21.2001 Kearney Cemetery • 1 310 CEMETERY OR CREMATORY LOCATION CITY OA TOMS STATE All Faiths Funeral Home 1 ❑ c.ASre " ❑°" j Kearney ,_Nebraska Mb_ FLRMAN. NOME ADDRESS CS - MELT OR RE.O. NO. CITY OR WAIN. STATE. 27PI 2929 S. Locust St. Gram* Island. Nebraska 68801 21 IM MEOIAiE CAUSE EWER ONLY ONE CAUSE PER LINE FOR lal al. ANO loll ZM PMT°1MER SIOMFICA CONDRINS X. Cmllsan OpiipuNpi6 IM AeWI dA 001 WSW Ma DATE OF "QUAY Att. Day. Yr.) G ARela) ❑ URGMNRn s ❑ ❑ Pstong ❑ Npna06 NHMg_Sd, 3, Peter Vs AEd6TRAR 27a DATE OF DEATH TAW.. Day. Yc) March 17, 2001 EM DATE SIGNED AN Day. YrI MaYC,h 21 20,0 WO M 25a �Q� *JURY AT 1 213 PLACE QE uRY /a. farm *eon. on. AIRY Yp ❑ No [3 dMCe 270. Town boa on ny .. - � / 6I y �� +�+ earplel7UN0. vV dG7 :41'1�� lnO / DID TOBACCO USE CON - TO THE DEATH? ❑ YES ❑ NO UNKNOWN Ledakis, MD, 2116 W 26c. HOUR OF INJURY 27c. TIME OF DEATH a S 5:00 a.M I a - wn aw due mthe MASSE AND ADDRESS OF CERTFIER :PHYSICIAN. CORONERS PHYSICIAN OR COUNTY ATTORNEY! /7 NA st Fa 201405923 68801 RSRTS I FEMALE. WAS THERE A I EM AUTOPSY I FREONANCY N THE PAST 3 MONTHS (AID 1 5-54I YS$ n No 1 IS I YeS ❑ Ns r 200. DESCRIBE NOW WLAUPY OCC� 265 LOCATION 24 DATE SIGNED STREET OR R F.0 NO AM: QM Pe, 2a PRONOUNCED DEAD AN MA ye I { h ram OF DEATH ARONOU10111 OEAO Le OR h ban d alarnNOOn W at niefo7Mi e. r R4 Wm* Open maim' a A are In* ON WO Olson AM Ale A1Mtaunt* MMW (S•RI,e ar10 T.R 9'16 I.'AS ORGAN OR TISSUE DONATION MEN CONbOEPED+ Mit WAS C NSE8T ORANTED 0 YES AIO ❑ YES ey Av.,Grannnd RE 68803 DAIS FiLED BY RForsri W /Ab Der Yr/ � swngKrMarlwMaNwawl f M •MNPI S sea1W Waist aI NYM rAK ar.Q t,�t l l WAS CASE I D TOMMIE . EXAMINER ORCORONBI7 riS N, CRY OR TOWN STATE M M