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<br />STATE OF NEBRASKA — DEPARTMENT OF HEALTH f1 (� O
<br />BUREAU OF VITAL STATISTICS 200003701
<br />V
<br />CERTIFICATE OF DEATH
<br />1 OF (;fDfNl NAME flnSi MIDRI.F ^•FX t DATF fIF DFATII ,Ah an O.sr Ynr,/
<br />Irma Marie Wilson Female October 19, 1995
<br />A C.I IYANT)SIA iT /K Ti7m Fi, rx,rnl r,r l,T n.lnrr rry /nhy/ Sq A(f 1,51 RnIM1ay I.INUFR 1,1 IT WS0111 I DAi R DATF KRfR.II -AivM An -0
<br />Naper, Nebraska n '83 °"O11C " " "' September 30, 1912
<br />7 Sr N.IAL SECllnll(IA IMRI., I) Ra 1'I ACC-OT DFA1H
<br />508 -38 -1.476 HOSPITAL t Ir,nnrne OHIFR u Mnamq lkmM
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<br />-- _ -- - -_ _-------------------- _.._._. I -1 F11 l,,AI`nlfrrN U Flr`oMrnr,•
<br />11b 1 ACIUTY - Nnmr (lI ry +l mchrnfirvr, grvr crnrl ,ne nunrhnrJ
<br />St. Francis Skilled Care Center ❑ D/,A ❑
<br />Rc CITY TOWN OR t(N:AIION Of DEATH --- - -_ - -— M INSIDE CITY LIMIIS RP COTINiv OF OFA111
<br />Grand Island yes U 1)g ❑1 — Hall
<br />9a RfelDENCE STATE 9b (:OIINtY Ih CIIY IOWN01FIL ;A11ON nA SINFEI AFIDNII)Anl'n Iln, lrnhnq
<br />Nebraska Nall - _ Grand Island _404 N. Eddy - 68801
<br />Yee
<br />10 PUCE leg Wn-te RIAfv A,-r..", It ANCFSIF1Y Ing IlAlinn Mrr cnn Onrman elrl 17 j -�j MARRIFU j -j WIDnWPD tl NAME OF SPONCF Ia Mdr nIe mirt..rrn,r
<br />ekllSr,,.rrp, IsIM.roI American �- NEVER nlvr)rIrFD Joseph L. Wilson
<br />White — --- ��L�1MA�sa��Q__ U -- -- 14a USUAL USUAL OCCUPATION il:rvr Mrndt+l PY+r4 AMM dlxing nh.I F1411 KIND OF RIISINFSS INDIISI RY IS tOl1CAl1ON ISprrdl q'h'Ingly/1 ¢1(M cgmpMl AI
<br />d.grlrngalr. nrM drrnratl flrrr rnflry n5!'.AfrnMn,v rn, ?I Cnnwq^ rr r
<br />Sales Retail Clothing 1L
<br />IR FAIRER -NAME Fa)Sl MII,f `IF IAS1 17 M,111FR IIIY.1 MII,NI( -- MAIDEN SIInNA),IT
<br />,Joseph NMN Prenger Rose NMN Brunning
<br />• 18 WAS DECEASTD FVFR IN ITS AIIMFD FORr'f S' 19P INF OTIMANI NAME
<br />IV" nu N unit I IR Yea grvP ..lr AM API I aP W-1
<br />NO - Roger Wilson
<br />J -_ _ - - - - -- - - - - - -- - - - - --
<br />19b INFORMANT MAIL IND AIIfNIf SS IS IIIF'FI OnnFD 11(). (:ITV DR TOWN S1AIf TIP)
<br />509 i.1Y.- AV ie Grand Island, Nebraska 68801.
<br />7D FM MfR- SA G� '/ 71A MF NIOD OT MiPO :I n()N 711E RAIF 71� r.F RIF IFHY f,n ('nF MAlr,ft) NARIF
<br />�` �/ [R)RnrIPI C,RenMVAI Oct. 21,1.995 Westlawn Memorial Par
<br />a fUNERA( )IA 2tr1 r ".PMF1FRY fHi Oill MAlnlll TO( -ANON 1)lv Dn TOWN
<br />Livi gston- Sondermann F.11. [ ]orm.Mkn []Rnr,,Ir,r, Grand Island, Nebrnsk
<br />226 FUNERAL HOME. ADOnrss IS 1nEFIOn RFO NO (.ITY(In )OWN SI AJF. 71P1
<br />505 West Koenig, Grand Island, Nebraska 68801
<br />7.l W["AAIF. CAIISF IFNtFn ONLY ONE CAI ISF PFD LINE FDR Inl I61. ANU Icll
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<br />PART
<br />tAj.QCrC)G(C
<br />OUE 10. On AS A C0N6FOUFNCF OF 1 IMP.vM IIP1.,r.n m, <.1 .
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<br />OUE to OR AS A CONSEOIIFNCE OF I MlervAl tMt.rMn rn,arr
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<br />O1),FR SK+IMICANI CON (M TK)NS CvrAiFnrM crMlr +IxdlnpM 1hn ADAM Iva rnarelalrA _ PARI M IF FF.MAL( . WAS THF,RF A 4 AIItDPSY s WAS CASE OF, E n,)tI
<br />PART FONANCY IN IHf PAST 3 MF)NIHS V EXAMINER tE C(NN,IO1
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<br />IAgrr510 -SAT Y" NO rVAa.L1 No Y Y"..7j- -_Ne
<br />2gq 211b DATF OF INJURY IM, Oay Yr) 2rk HOUR OF MJIIRY 2RA. DESCFIIRE HOW INJURY MCI1RRFD—
<br />A,,W.M Cl I1nAPle.mingA - M
<br />El SuA:M/ LJ PerKhflq ?Re RI.IUFIy AT WD/II( Nil PLrpe r,iN, WY +er I1rm, n11e1R I1Hmy 7fip LO[:A11pN SIRFFI On RF.O NO CITY (NI T(YWN
<br />qIF II w (-fir Iii
<br />0 H—w4d I fn afiq tmn Yea U Nq
<br />27a DAZE Dr DEATH Mfir Oay YrJ 7RA DAIF SKTNFb IMr+ /lnv vrl ?lal 11ME OF DEAIH
<br />y 5 _ -- is 31 — — —
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<br />276 DATF SpiNFD IMr+ OC.aY )rte 77771, TIME OrFFAIH 211, F`n NJOUNCFO OFAR 1Afi, Day ),I ?IM PRD110LNCFn RFAU r +4
<br />• s 21,1 In Il,n Mal d my •mvMrkM rvrnrreA al Il,e hnM alt ,yM M (1rM M dle , E 'JRP LM a,r bnais la r.AnunnlAK, nrM rn InvrM,pinpf. M my gwArn APA1, rx rrnPA e•
<br />nM (Ilrr M M+e emnPlsl MaMM.
<br />SI�naPreandTMelt— ,%c/v�'w' ►/ �1/ —r/-+l hasanetgkl 11. _ _._- .......
<br />?9 qO TOBACCO USE CONI,IIRIJIE 10 THE DEATH? 30a HAS ORGAN OR TISSUF DONATION OFE CONSIDERED' In h WAS CONSENT GRANIEDT
<br />J( 0 VFS NO � UNKNOWN X E] YES NO )f — YES
<br />31 NAME ANOAWFTFS SOF CERTIFIER (PHYSICIAN,CORONFnSPHYSICtANOR COUNTYA7TORNEV) (TK- (N / / /PnM�� -1 ��.
<br />- D. R. Colan, M. D,,__729 N. Custer, Grand Island, Nebraska 68803 _ _
<br />32a REGISTRAR 7?b DATFFRED5YPF(1v;y.R &* Oay VrJ
<br />FOR VITAL STATISTICS USE ONLY
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<br />Place....................... A ................................ B ............... ... .............. C .............. .................. D ................................ E ................................ Part 11 ...................... TMV .....
<br />NSC.......................................................................................................................................................................................... ............................... ......................... Census T I I,) r
<br />Work........................................................................................................................................................................................................................ ............................... .
<br />UC......................................................................................................................................................................................................................... ...............................
<br />Rejecl................................................................................................................................................................................................................. ...............................
<br />aPflnfAd AP, IM P. r eyrlAa PAPA, tj
<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 />hereby certify this to be a true and correct copy of the original
<br />sled with the State of Nebraska
<br />ice, by
<br />� GENERAL NOTARY_State Of Nebraska
<br />Signed in my pres a ^� day of- aaoo TERRYL LOSCyEN
<br />MY COMM.. Exp, -o ff
<br />Notary Public
<br />
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