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<br /> WF�N TFNS COPYCA/t�tE3 THE RAI3ED SEAL OF THE II�BFASKA F�AL)fI All�.�{,[�/ASI SERVICES
<br /> SYSTEII�IT CERTI�S TF�BELOW TO BE A TRUE COPY OF THE OR/OUW1F� :�1f1�J{,E W/TH
<br /> THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM,V/TAL STA��_�CH/S
<br /> THE LEQAL DEPOS/TORY FOR VITAL RECORD3. -' - - -
<br /> DATE OF/SSUANCE - � _��'
<br /> DEC 3 01999 20 A8�0�8 �. ,�.,,;;�,.�,��,R
<br /> UNCOLN,NEBRASKA HEALTH# �M
<br /> ..,:.�._ .�.�
<br /> STATE OF NEBRASKA-DEPARI'MENf OF HEAI.TH AND' A ERaVi�,�E AD�SUpppRT
<br /> V1TAL STAiiS17�S=. ' __-- : . ' -`=
<br /> CERTIFICATE OF DEATH"'��`���-�=
<br /> 1.DECEDENT-NAME FIRS7 MIDDLE LAST 2.SEX 3. OF DEATH /Monfn.Dav�eaq
<br /> Lawrence Anthony Murphy Male December 23, 1999
<br /> 1.CITV AND STA7E OF BIRTM /ll npf n U.S.A.nams epmhy� Sa.AGE-Last Birlhday UNDER 1 VEAR UNDER�DAV 6.DATE OF BIRTH /MpiO'r.Day Yea�l
<br /> Greeley, Nebraska ��15�3 Sb MOS I oA�s 5c.HOURS' MINS MFOUcL 9, 1936
<br /> Vl.l.
<br /> 7 SOCIAL SECURTIV NUMBER 8a.PLACE OF DEATH
<br /> � 508-40-0004 HOSPITAL � Inpatiertl OTMER � Nursing Home
<br /> � Bb.PACILITV-Name lM rror msf�lufan,give sneel and number) � ER Oulpauent � Resitlence
<br /> , St. Francis Medical Center ❑ �^ ❑ ahe�,s��,��, _.____
<br /> Bc CITV.TOWN OR LOCA710N OF DEATH 80.INSIDE CITV LIMITS Be.COUNTV OF DEATM , ,'.�fi�: � `.
<br /> Grand Island Y.. X � � �° --
<br /> 1i �TE'-- - � 96:C 9c.CITV.TOWN OR LOCATION 9d.STREET AND NUMBER /Including2ip Cotlel 9e INSIDE CITV uMITS
<br /> Nebraska Hall Grand Island 1706 N. Park Ave. 68801 �eSXQ No❑
<br /> 10.RACE-(e.q.,Whde.Blatk.Amer�can Indian. 11.ANCES7RV le.g..Malian.Mecican.Ge�man,etcl t 2.�MARRIED ❑WIDOWEO 13 NAME OF SPOUSE /ll wde.grva maiden name)
<br /> e1c.11Specdy� r.�l�e (Spealyl p�rican NEVER DIVORCED Donna Latham (Lee)
<br /> Y711
<br /> iCa.USUAL OCCUPATION /Grve kind d wwk daM during mvsl 1 Cb KIND OF BUSINESS INDUSTRV 15.EDUCATION (Spemly only hghsbt qraOB tanpletetl)
<br /> d wwk� 4/e,e remedl Elementaryqr,�eCorMary 10�12� CoNeye I�-a or 5•i
<br /> �ir orce Recruiter U.S. Government ��
<br /> 16.PATHER-NAME FIFST MIDDLE U1ST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME
<br /> Earl Murphy Mary Trela
<br /> 18.WAS DECEASED EVER IN US.ARMED FORCES? 19a.INFORMANT�NAME
<br /> I�es n�.or unk.) Itt s. e r an0 Oates W 9-3-�4
<br /> Yes: 5-'�5�-��1 9-1�-�3 -�'�`75 Donna Murphy
<br /> �9D MFORMANT MAILING AUDRESS ISTREE�OR N F 0.NO_CITY OR TOWN.STATE.ZIPI . �
<br /> 1706 N. Park„Ave. , Grand Island, NE. 68801
<br /> 2U.EM MER-SIGNATURE6 SE ` ��/ 21a.METhq00FqSPOSIT10N. 21b DATE �27c CEMETERVORCREMATURv NAME
<br /> CJ
<br /> �� �Removai Dec. 27, 1999 Westlawn Memorial Park
<br /> Pa.FUNERAL HOME-NAME 2tG.CEMETERY OR CREMATORv LOCA710N pTv OR 70WN STATE .
<br /> Apfel-Butler-Geddes ❑�"°^ ❑°onao°^ Grand Island, Nebraska
<br /> 22b.FUNERAL FIOME ADDRESS (STqEET OR R.F.D.NO..CITV OR TpWN.STATE,21P�
<br /> 1123 West Second, Grand Island, NE 68801
<br /> 23. IMMEOIATE CAUSE IEN7ER ONLV ONE CAUSE PER LINE FOfi IaL Ibl.�D(c�� IMerval Uelwaen onut a��a oeair
<br /> PARI I AG V 1 �.. �y i
<br /> � WE TO,OR AS A CONSEOUENCE OF I Imerval benveen anael an0 dealn
<br /> i
<br /> 'b� i
<br /> I
<br /> DUE TO.OR AS A CONSEOUENC[OF� � trner�n.oetwcen oncat an�tlea!n
<br /> I Ii
<br /> �c� i
<br /> OTHER SIGNIFICANT CONDITIONS-Contldion5 Con�nMAng M the tlea�h bu!no1 releled PART III IF FEMALE.WAS THERE A 2< AUTOPSY 25 WAS CASE HEFARED TD MEGICAL
<br /> PART � PtiEGNANCV IN THE PAST J MONTHS? E%AMINER OF CORONEF� �
<br /> II
<br /> (Ages 70-54� Yes No Yes No Yes No
<br /> 26a 26b DATE Of IWURV (Mo..Day.Vc) 26c.HOUR OF INJURV 26A.DESCRIBE HOW INJUHY OCCURRED
<br /> � ACCiCOn� � UlMetermmeG M
<br /> � � SulcWe � PerWing 26e.INJUfiV AT WORK 261.PUe EO�.���������arm.stree�.facbry 26g.LOCATION STqEET OR R.F.D.NO. G7V OR TOWN STP.TE
<br /> ❑ ❑ ❑ o� bu
<br /> Mpnicide InvesUgalion Yes No
<br /> 27a.DATE OF DEATH /Mo..Day.Ycl ( 28a.DATE SIGNED lMo..Day Vr 1 28b TIME OF DEATH
<br /> E��i ` Y, �.� �l 1 � 3�=z M
<br /> �A 27b.DATE SIGNED / ..Day.1tl 27a 71ME OF DEA7H �C 28c.PRONOUNCED DEAD /Mo.Day.YrJ 280.PRONOUNCED DEAD /Fburl
<br /> �� (a �-� �� �i ' ySfrm M �w�� M
<br /> �� 27d.To tlie 01 my knowle0ge.E occwred at tly ti ,Oate antl place anA due to ttie � ��� 28e.On ihe basis of eraminau arW�a invesugauon,in my urreC at
<br /> causelsl stated. � the time.dale and place a e e to Me c �
<br /> IS naWre antl Tille� � �nedue and 7
<br /> 49.DID TOBACCO USE CONTRIBU7 0 THE tH? � 30.a HAS ORGAN OR 71SSUE DONATION BE N CONSIDERED? 30.b wAS CONSEN7 GRANTED�
<br /> � VES � NO s � UNKNOWN � �ES � NO � VES NO
<br /> t-�
<br /> 31 NAME AND AODRESS OF CERTIFIER(PHVSICIAN,CORONEP�S PHVSICIAN OA COUNTV ATTOANE�I lType a Prinp .
<br /> Barton D. Urbauer M. . 2444 Faidley, Grand Island, NE 68803
<br /> J2a.F�GISTRAR 32D.DATE FILED BV BE�$T�AR JA1�Day,yr�
<br /> DEC 2 .� 1�
<br /> T,nts Sixtv-nine (69l and Seventv (70), West Lawn Addition to
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