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0 STATE OF NEBRASKA WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAR e Al LITN,AND HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OFT a cs•IGINAL.• 04)ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SE/113 0—,cli , !' C p. , OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS 1 -', et ' DATE OF ISSUANCE ' ' e i a ' 6TA ri :1�4 • R: er3 APR 15 2008 201502224 ; , ASSISTANT STATER CiiS PARTMEN'T OnR,( RAtg t:AND LINCOLN, NEBRASKA - 5 ' STAIEOF NEBRASKA-D8ARTI ONTOF HEALTH AND 1RalAN amass FBNANLITA? "� • VITAL STAVm11CS V 06952 CERTIFICATE OF DEATH T DECEDENT-NAME FIRST MIDDLE t T 2 SE71 3,DATE OF DEATH Wow Om 1 Linda Mae Baasch Female . June 10, 2003 ' A CITY AID STATE OF 8RTH MAeIO USA.IlaW,401aaYe 5a.AGE-Lae BI,1OW UNDER!YEAR UNDER 1 DAY 6 0111E OF BIRTH MOM L 'min Grand Island, Nebraska Ms.! 64 I DAYS Mw5 October 10, 1938 . 7 SOCIAL SECURTIY NUMBER Se PLACE OF DEATH -506-40-1331 • HOSPITAL ❑ eosins OTHER ❑ Meese Isms* -lb FACARY•W,r IOANWI•*OR OI9**Mane/eIMMJ ❑ ER Wpm. Q Rae14aaes . 3180 South Blaine Street 0 DOA ❑ Ow dose*. CITY TO`.ei OR LOCATION OF DEATH . Be INSIDE CITY LIMITS 8.COUNTY OF DEATH Grand Island . Yea E3 ND ❑ Hall 9e.RESIDENCE•STATE 915 COUNTY —Be CITY.WAIN OR LOCATION 80.STREET AND NUMBER !/neAdlg2b C4aIN Be INSIDE CRY LYTS 68801 Nebraska Hall Grand Island 3180 South Blaine Street • V•® Na❑ . 10 RACE-N9•Mars Nees.ArnMraan arse. II.ANCESTRY vs.MIA Mynah.Gomm Mel 12.®MARRIED 0 WIDOWED 13 NAME OF SPOUSE M.�rr gemmed emege Mellsoaahn White ISB.eMyl Danish DNEM' IED L❑J x"RGED Bill Baasch 144 USUAL OCCUPATION /Gem aaMofacla dons duinOmDM Tub KIND OF BUSINESS INDUSTRY 15 EDUCATION I5WCMOnly INJWN¢adeemw oq daonlag NE mina ! EWeenWY or Seameam 00.121 (.aY,e 11-4 p 5•1 Bookkeeper 1 Bill Baasch Welding 12 16.FATHER-NAME FAST MIDDLE LAST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME Edmond Van Trump Alice Reinecke 10.WAS DECEASED EVER N US.ARMED FORCES? 19a INFORMANT-NAME (Yes.no.oruNM I Ia Yes.ese 4Y AM Mies NUMW:ea1 • no 1 Bill Baasch 19b.INFORMANT MAILING ADDRESS - {STREET OR RF D NO..CITY OR TOWN STATE.WIN - 3180 South Blaine Street Gra d Island Nebraska 68801 20.EMBAUIER-SIGNATURE 6 LICENSE NO a METHODOF Dr:POSITON 215 DATE 121c CEMETERY OR CREMATORY NAVE +rimer 213..1 ❑RAAAHA June 14, 2003 1 Grand Island Cemetery 22•i i.- NAME 214 CEMETERY OR CREMATORY LOCATION CITY OR TOWN STATE Apfel-Butler-Geddes ❑Cuonshon ❑Donato, Grand Island, Nebraska •._ 1 220.FUNERAL HOME ADDRESS (STREET OR RF.0 NO.CITY OR TOWN.STATE.21PI 1123 West Second Street, Grand Island, Nebraska 68801 23. MEDIATE CAUSE ,�,�-M {ENTER ONLY ONE CAUSE PER LINE FOR ral IDS AND MK ealNal WNW meal ems Oeaa. PART 1 1/ !u�T(�S�JRA•1 � �.+�. C. ;Q�rt A. 2 W e e f�..s ,TO.OIT AS A CONSEQUENCE OF ............ara deal' ,D, fir r✓e- 5 kbCerfi a at de me•,t�cz, appra,c 5 t 4"S DUE TO.OR AS A CONSEQUENCE OF lnadval MAIM am 11560 1 (C) PAR-OTHER SIGNIFICANT CONDITIONS-Cd SSon.Nottebting To er 4eael but 901 1 PART II!IF FEMALE WAS THERE A 124 AUTOPSY 25 WAS CASE REFERRED TO a1EDICAL• PD S 0 I L ti I 'Rut re i d PREGNANCY IN THE PAST 3 MONTHS, I I EXAMINER OR CC;gNER+ 6 DS FL r�nsi�n �se�tse - _ lA9es 10-5U Yes ❑ No ®I Yee ❑ No ® Yea ❑ No lid 26a 260 DATE OF INJURY Mb DIY F,) 2Ec HOUR OF INJURY 1 264 DESCRIBE.HOW INJA MY OCCURRED ❑ ACr4xM ❑ UMH.nllrsd - M ❑ E WAN ❑ PendWD 26e INJURY AT WORK 1 261 ACE GF URY r Dome tam R:eet Iaegry 1 269 LOCATION STREET OR R F 0 NO CII v OR TOwh STATE Lr blMa xYl El HomKde In'alADgiMM yes❑ Na❑ I 279 DATE OF DEATH iMn Oar 1 26a tIATE SIGNED AAA ON v.r 12915 TARE OF DEATH June 10, 2003 13 l.. I {{� I, 27:DATE SIGNED /Mb Day Yrr 27e TIME OF DEATH 28c PRONOUNCED DEAD .Mo DAY 10l 1 264 PRONOUNCED DEAD IMo. Seg L—ti-Zo3 17:45 M l d M 0 274 To the baaol my weed 860 CarNS,aleiad. olate and due I::the ., gas Oa tae bur al e•aF1 nation ant,rn..vaalganoa.m my epnw aeala ocaaned at Ihs!!me data and Diate irk:due b Me caaaetal sm1ed •iSgnNU11eM RAN/��•�- r tS....and TIel, 29 ND TOBACCO USE CONTRIBUTE DEATN� � 30a HAS ORGAN OR TI ATgN SEEN CONSIDERED' 1300 WAS CONSENT GRANTED' ❑ YES ® NO ❑ UNKNOWN ❑ 'ES ® NO D YES ® NO 31 NAME AND ADDRESS OF CERTIFIER/PHYSICIAN.CORONER 5 PHYSICIAN OR COUNTY ATTORNEY Twee et Pant! Steve Husen M.D. 2116 W. Fai ley Ave., Grand Island, NE 68803 32a REGISTRAR 1325 DATE FILED 11 GLSTMR /AA1 Y.1 J1N2023