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� � _ ""~� . <br /> m �" <br /> ;' n n ` � � � o -"'-+ o � <br /> � °''� � � c_ c 2s � � <br /> � D C. � <br /> = C.� � � � --�� � <br /> �' 0`�t � O 'TI � N <br /> a,( � � Q � <br /> rn ��'b �" � <br /> � � 'Z7 a� a� p <br /> � F� � � � b o � <br /> �� <br /> rv � "� .-��r <br /> � � vv � � <br /> C.:.7 � � O <br /> � <br /> Legal Descripti�n: <br /> The South �'en (lU' ) Feet of Lot 5ixte�n (16) and all of Lot Seventeen (17) � in Wolte's <br /> Subc�ivisi��n, in the Cit �,f c:,rand Island, Hall c.�unt_y� Nebr�ska. <br /> �_ <br /> �� <br /> - ,� G <br /> WHEN TH1S COPY CARR/ES THE RA/SED SEAL Of THE NEBRASKA STATE DEPART�O�'1�►�Zy, � <br /> /T CERT/f/ES THE BELOW TO BE A TRUE COPY Of AN OR/O/NAL RECORD ON�'��� <br /> DEPARTMEN7 Of HEALTH,SUREAU Of V?AL STAT/ST/CS, WH/CH/S THF L�#L D�SiI'���K_ <br /> V?AL RECORDS. _ T <br /> DATE OP/SSUANCE - �����" = <br /> JUN 19 1996 2dfJ�d � ��0 =-�-__ ��-__ :� <br /> ASS/STi�tIF��: _ <br /> UNCOLN,NEBRASKA NEBRASKA DE^� ��� <br /> STATE OF NEBRASKA-DEPARTMENT OF HEALTH _- = <br /> BUREAU OF VITAL STATISTICS .. <br /> CERTIFICATE OF DEATH <br /> i DECEDENT-NAME FIRST MiDDLE LAST 2 SEX 3.DATE OF DEATH iMon�n Oav.✓earl ��� � <br /> Howard Robert McGee Male June 16, 1996 <br /> <.CI7V AND$7ATE OF BIRTH /IlnOf ir USA..name cWnfry) Sa AGE-last BirihCay UNDER 1 VEAR UNDER 1 DAY 6.DATE OF BIRTH /MOnM.0ay.Yeai! <br /> Aurora,Nebraska �Vrs1 72 Sb MOS i DAVS Sc.HOURS' MiNS DECCIIIUeP O4, 1923 <br /> 7.SOCIAL SECURTIV NUMBEF 8a.PIACE OF DEATH <br /> 508-12-7535 HOSPITAL � Inpatient OTHER � Nursmg Home <br /> BE.FACILITV-Name (MnofrnsfilNipr.9ivesheela�dnumberJ -���- � EROulpatien� � ReS�aence <br /> St.Francis Memorial Health Center ❑ ooA ❑ ahe�rso���ty� <br /> Bc.CITV.TOWN OR LOCATION OF�EATH � 8tl �NSIDE C�TI'LIMITS ee.COUNTV(�DEATH � <br /> Grand Island �es [� N� ❑ Hall <br /> 9a.RESIDENCE-STATE 9b.COUNTV 9c.CITV.TOWN OR LOCATION 9d.S7REET AND NUMBER (Includ�ugZip Codel 9e INSIDE CITV LIMITS <br /> Nebraska Hall Grand Island 3008 W. North Front Rd.,68801 �e5 X� No❑ <br /> 10.RACE-(e.g.,W�ite.Black.Amerlcan Indian. 1 t.ANCESTRv le g..Italian.Mezican.German,elcl 12.�MARRIED ❑WIDOWED 13 NAME OF SPOUSE /ll wr/e.give maMen name) <br /> °��� '�`merican NARER DIVORCED Louise Triggs <br /> 14a.USUAL OCCUPATION IGrve kmd d wak done Cunng mosf 1<b.KIND OF BUSINESS INDUSTRY 75.EDUCATION (Speary onry nglies�grade compleieC) <br /> d mxkiig IAe,even d ie�iredl Elementaiy w SeconOary 10��2I College n-n or 5-i <br /> Driver Trucking 12 <br /> 16.FATHER-NAME FIRST MIDOLE LAST 17 MOTHER FIFST MIDDIE MAIDEN SURNAME <br /> �lyde C. Mc�ee Eth2l Wilson <br /> 18.WAS DECEASED EVER IN U.S.ARMED PORCES7 O�IIIS/I94I-- 19a��NFORMANT-NAME <br /> (Ve no.a unk.� III es.g�ve war and dates d servlces) <br /> 51'es �Vorld War II 12/31/1946 Louise McGee <br /> 19�.MFORMANT MAILING ADDRESS ISTREET OR R.F.D.NO.,CIN OR TOWN.STATE.21P) <br /> 3008 W. North Front Road,Grand Island,Nebraska 68801 <br /> Z0.EMBALMER-SIGNATURE 6 LICENSE NO. 27a METMODOF q$POSIt10N 21b.DATE 21G CEMETERV Ofi CREMATOA��NAME <br /> � �,�p ❑a,��a� ❑���a� Jut�e 16,_1 Central NE Cremation Service <br /> 22a.FUNEML MOME-NAME 21tl.CEMETERV OR CREMATORV lOCA710N CITv Oc7 TOVJN SiATE <br /> Apfel-Butler-Geddes Funeral Home X❑c�� ❑o«�a��«� Gibbon,Nebraska <br /> 22b.FUNERAL MOME ADDHESS ISTREET OR R.F.O.NO_CITV OR TOWN.STATE,ZIP� <br /> 1123 West Second Grand Island,Nebraska,68801-5899 <br /> 23. IMMEDIATE CAUSE IENTER ONLY ONE CAUSE PER LINE FOR lal.(b�.AND�c�) � �Merval between onset antl oeam <br /> i <br /> PART �oO . i WLf. <br /> I <br /> lal � <br /> DUE 70,Ofi AS A CONSEOUENCE OF� � Imerval be�ween onsel antl tleam <br /> lol I�i <br /> DUE TO.Ofi AS A CONSEOUENCE OF: Intervai benveen onset an0 tleam <br /> I�I � <br /> OTHER SIGNIFICANT CONDITIONS-ConCilions convibutinq to the tleaM Du�nd related PART III IF FEMALE.WAS THERE A ' 2< AUTOPSV 25�EXAMINER OR CORONEA MEDICAL <br /> PART PREGNANCV IN THE PAST 3 MONTHS <br /> II <br /> (Ages 10-5<) �es No Ves No Ves No <br /> ny. 26b.DATE OF INJURV /Mo.Day.Yc) 26c HOUR OF INJURV 2fid.DESCRIBE HOW INJUR�OCCURRED <br /> � Accident � UnCetermineC p,� <br /> � SulciAe � Pentlirg 26e.�WURV AT WORK 26f.�PLAe��_I�Nd�RY%��I,farm,svce1.facbry 26g.LOCATION STREET OFl R.F.D.NO. CiTv OR TOWN STA7E <br /> If <br /> � Hpnwitle invesuqatron Ves� No� <br /> 27a.DATE OF DEATH /Ab..Oay Yc/ 2Ba.DATE SIGNED /Ab..Day YrJ 2B0 71ME OF DEATH <br /> a= June 16. 1996 ��_ "" <br /> E yvY, 27b DATE SIGNED lMo.Day.YrJ 27c TIME OF DEATH �`} 2Bc.PAONOl1NCED DEAD /Mo.Oay.Yc1 280.PRONOUNCED DEAD /Hourl <br /> ��� � i�I9y O:W e1M ��=o� M <br /> o� g Z <br /> 27C To the best d my knowledge.death occurretl a�Me time,tlaie antl Wace aM tlue to ihe �g c� 2Be.On the basis d examinauon anA�a mvesugatwn.m my opnan tleam occurred ai <br /> ~ c causels�stateC. /�_ _ �/„ c� o Me ume,Ca�e and place and Aue to�he causels)stated. <br /> G�.��1/^.l I'v <br /> �Si nature antl Tille► e anG Tide► <br /> 29.D�D TOBACCO USE CONTRIBUTE i0 THE DEATH7 30.a HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED7 30.D WAS CONSENT GRANTED4 <br /> VES � NO � UNKNOWN � �ES � NO �VES � NO <br /> 31.NAME AND ADDRESS OF CERTIFIER I�M�SICaN,COfiONER'S PMYSICNN OR COUNTV ATTOFlNEVI (Type p PrarfJ <br /> Dr.Anne K.Morse,729 N.C�ter Ave.,Gra�d Island,Nebraska 68803 <br /> � � �� <br />