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<br />STATE OF NF•BRASKA- DEPARTMENT OF HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT
<br />VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />— _
<br />Nebraska Hall Grand Island 1404 N. Eddy 68801
<br />to hA(F I.q Wh?. IIA•'. I1 ANCFSInv I n IWn Mnnr4n G4rmen. 0101 12 (''MARRIED (WIDOWED 15 NAMFM RPOvII[ P.." Pv1 ny M•• nen )
<br />.If 11SnrrAYl ISnnr avl U NEVER u DIVOnCED
<br />White American ❑MAaRIER__ Irma M. Prenger
<br />tae 'JSUALOCCUPANON rG•I. Imd nr xrr4 dnnP AurrnO mn.ar — � _ 14h NINDOF8lISINF.SSINDUSIRY IS EDUCATION 1$1)KAy or41'11Ip11,M OrhOe AenIpl,lsO1 -- -
<br />rrnn.A •/, ,n Arer.rt rl, Retail Sales — Fk 1 •T S[Sml•Y I 17i Dgeegf n an•...-
<br />a�lesperson _ Se_ars & S erry Hutchison tI Gra�e
<br />•A FATHEn.NAME FIRST I,AIDDIF LAST 17 MOTHER FIRST wnnlF MAIDEN SURNAME
<br />Joseph Lockhart Wilson Sr. Brid et NMN Kinne
<br />• rn 7 %ac DECEASED F':Enni _.._...__.____. _.
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<br />U S ARMFU FORCES' IRA INFORMANT NnMF —
<br />Ives ••, n• „nk 1 IN ynq Tvn w4r — •!dins nl 50rv�q.p1
<br />No - - - - - -- Roger Ro Wilson
<br />- -- -- --- - - - -- - - - - --
<br />•nh nlf gnrMNT - — MnII IU ^. ADnnFSS ISInFFt OR RFO NO ryTV OR TOWN STA rF ZIP)
<br />509 Linden Ave., Gr_and__Is_la_n__d, Ne. 68801
<br />7R FMB/jl MTfjR �SIGr(AIl1n/1�
<br />FU SE NO 21. METHOD OF DISPOSITION 71h DATE 121, CF11F ?FRY OR CREMATORY NAME
<br />Dec. 5 1998 Westla_wn Memorial Park
<br />22. r1)NFRALH NAMF �"''' 71d f,FME T ERY OR f_ RE M A T On* LOC A T ION CITY On TOWN S/11F
<br />Livin stop- Sondermann F.H. U`re•,AlIm ❑`" " " " "' Grand Island, Nebraska
<br />7711 FUNERAL HOME ADORFSS "STREET ORRFO NO CNV On TOWN SIATF. 71P1
<br />601N. Webb Road, Grand Island, Ne. 68803 -4050
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<br />Glt DUE TO, OR AS A CONSEOUENCF. OF — ---- - - -_ -- I Ir4e•vel h,lw,en 4100 A +.• •••.- -
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<br />0THF0 51GNIFICANI COND111ON$ C1TAUnn[ C1n1nWXmq In Ih. AeAlh MA npl rPlpind PART III IF FEMALE WAS THERE A 114 AUTOPSY PART ZS WAS CASE REFERRED TO MF`,n•e.
<br />I PREGNANCY IN THE PAST J AAORTHS? _ YE %AMINER fq�I1CORONFR�fr-
<br />A IA9ef 10 541 Yee El Nq E] Yoe r 1 Now ' 1 YM 1 1 w
<br />7AA 7411 DATE OF INJURY (Mn DAV Yr) 7Ar HOUn OF INJUnY 7RA DESCRIBE HOW INJURY OCC,UnnFD
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<br />r _ nlf�r F � rp n hOm!'Ibm 011..1 IACIpY 79q LOCATION STREET On RFD NO C1ty OR TOWN 1re•r
<br />`.� /Mmr MA hl vntl. ?AI•nn V.s No O
<br />X7774 DATE OF DEATH iMn DAT Y "rl 78A DATE SIGNF.D (Mn DAY Yr l 7Ah TIME OF DEATH
<br />7711 DAIF SIGNED /Ann DAL Yrl 7`7 /TIME OF DEATH I' T 7A, PRONOUNCEDRAn rArn V*y V,) 7LIO PRONOUNCED DEAD 70;r ••
<br />77A 1 Irte IJ4M d my knnwlr Ih nrrinrM AI l ro •TAT. nntl Arx In At. a 2M On the hefts d efeminetlgn APO W 01V"I" M. 0 my ep WK MAIN n(c1A•MI M
<br />AIIinlcl 01.1.4 f Th. Irn•rl. AMP And PIA[! AM"M TT* ca,,."91 8.100
<br />�ih)rf frM Ttee) It ^ n _ . , '• MIT! TpN�
<br />71 010 IOBAC.CO NSF CI)NInIBi)TF O THE OEATH'7 7I�%—Ia HAS ORGAN On TISSUE ""NATION BEEN CONSIOERED'' ; nh WAS CONSENT GRANTED? — -
<br />Y E5 NO UNKNOWN I X ❑ YES 1?{. NO 1_�' � YES NO
<br />?I N_A—ME AND ADDRE SS ^O =F�I%A l0IPE�NYY(; I. N, ypR(1NEpgpLIV91C1AN}�O�R'COUNTY ,TT(YRNFYI (TYyE OrRYrrN`I-'
<br />?7A RF GICTRAR
<br />37h DA IF FtI.En BV REGISTRAR (AAq My Yr)
<br />FOR VITAL STATISTICS USE ONLY
<br />Place....................... A ................................ B ............. .................. C ............................... D ... ... ..................... ..... E ............. .......... .... .... Part II ...................... TMV
<br />Reject
<br />PrinlrA wIlh toy Ink nn r Y,,l.d PAn.r
<br />LEGAL: South One -half (S1 /2) of Lot Ten (10), in Block Six (6)
<br />Gilbert's Second Addition to the City of Grand Island, Hall County
<br />Nebraska
<br />I hereby certify this to be a true and correct copy of 'the oribina
<br />filed with the State of Nabraska
<br />OG I U J n �v{s�, `by`�Qq ✓rn
<br />t4�L__ 14,.„,_ b �.
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<br />Signed in my presen a ay of >'Iai, , �.�
<br />Notary Public
<br />Q NERAL NOTARY -State Of Nebraska
<br />TERRY L. LOSCHEN
<br />My Comm• Exp. a �
<br />I C Fl?EN7 . NA!1F FInSi MxiOLF LA51 7 SEX 1 DATE OF DFATH •Al, n DAY ?'!AA
<br />Joseph L. Wilson Jr. Male December 2, 1998
<br />— .
<br />.•A.nr crAmrrv) -
<br />Greeley, Colorado 89 — August 26, 1909
<br />7 Sr',,At SFrlln ll'r I!'P/'RFn a
<br />aA FLACF OF DEATH
<br />506 506-09-5030 -
<br />HOSPITAL [� InPAOMt OTHER ® NvanyNOnP
<br />ER 0004001" ❑
<br />MAMPrIT!
<br />4h r A' x n r . NA•n. �---"- (No" m010hnn, 0— phrrl n, —rn ,,,,,nnrr� — -- -- -- E
<br />St. Francis Skilled Care Center ❑
<br />❑ DOA ❑ Oth!•,Srrv•h'
<br />A, nn � TOWN OR lnf.n Hny rjr OFnTH Ad INSIDE COT LIMNS q. COUNTY OF DEATH
<br />Grand Island _
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<br />Glt DUE TO, OR AS A CONSEOUENCF. OF — ---- - - -_ -- I Ir4e•vel h,lw,en 4100 A +.• •••.- -
<br />roI I
<br />OMM AM
<br />1
<br />0THF0 51GNIFICANI COND111ON$ C1TAUnn[ C1n1nWXmq In Ih. AeAlh MA npl rPlpind PART III IF FEMALE WAS THERE A 114 AUTOPSY PART ZS WAS CASE REFERRED TO MF`,n•e.
<br />I PREGNANCY IN THE PAST J AAORTHS? _ YE %AMINER fq�I1CORONFR�fr-
<br />A IA9ef 10 541 Yee El Nq E] Yoe r 1 Now ' 1 YM 1 1 w
<br />7AA 7411 DATE OF INJURY (Mn DAV Yr) 7Ar HOUn OF INJUnY 7RA DESCRIBE HOW INJURY OCC,UnnFD
<br />A.fMnl � Ihd.Irrmm.A � M
<br />n Srrr.M n I -- a 7A. IN)l1RY AT WORN 7c1 PLAnF ,%JNJURV A
<br />r _ nlf�r F � rp n hOm!'Ibm 011..1 IACIpY 79q LOCATION STREET On RFD NO C1ty OR TOWN 1re•r
<br />`.� /Mmr MA hl vntl. ?AI•nn V.s No O
<br />X7774 DATE OF DEATH iMn DAT Y "rl 78A DATE SIGNF.D (Mn DAY Yr l 7Ah TIME OF DEATH
<br />7711 DAIF SIGNED /Ann DAL Yrl 7`7 /TIME OF DEATH I' T 7A, PRONOUNCEDRAn rArn V*y V,) 7LIO PRONOUNCED DEAD 70;r ••
<br />77A 1 Irte IJ4M d my knnwlr Ih nrrinrM AI l ro •TAT. nntl Arx In At. a 2M On the hefts d efeminetlgn APO W 01V"I" M. 0 my ep WK MAIN n(c1A•MI M
<br />AIIinlcl 01.1.4 f Th. Irn•rl. AMP And PIA[! AM"M TT* ca,,."91 8.100
<br />�ih)rf frM Ttee) It ^ n _ . , '• MIT! TpN�
<br />71 010 IOBAC.CO NSF CI)NInIBi)TF O THE OEATH'7 7I�%—Ia HAS ORGAN On TISSUE ""NATION BEEN CONSIOERED'' ; nh WAS CONSENT GRANTED? — -
<br />Y E5 NO UNKNOWN I X ❑ YES 1?{. NO 1_�' � YES NO
<br />?I N_A—ME AND ADDRE SS ^O =F�I%A l0IPE�NYY(; I. N, ypR(1NEpgpLIV91C1AN}�O�R'COUNTY ,TT(YRNFYI (TYyE OrRYrrN`I-'
<br />?7A RF GICTRAR
<br />37h DA IF FtI.En BV REGISTRAR (AAq My Yr)
<br />FOR VITAL STATISTICS USE ONLY
<br />Place....................... A ................................ B ............. .................. C ............................... D ... ... ..................... ..... E ............. .......... .... .... Part II ...................... TMV
<br />Reject
<br />PrinlrA wIlh toy Ink nn r Y,,l.d PAn.r
<br />LEGAL: South One -half (S1 /2) of Lot Ten (10), in Block Six (6)
<br />Gilbert's Second Addition to the City of Grand Island, Hall County
<br />Nebraska
<br />I hereby certify this to be a true and correct copy of 'the oribina
<br />filed with the State of Nabraska
<br />OG I U J n �v{s�, `by`�Qq ✓rn
<br />t4�L__ 14,.„,_ b �.
<br />y
<br />Signed in my presen a ay of >'Iai, , �.�
<br />Notary Public
<br />Q NERAL NOTARY -State Of Nebraska
<br />TERRY L. LOSCHEN
<br />My Comm• Exp. a �
<br />
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