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I. DECEDENT - NAME MT MIDDLE LAST
<br />Linda Mae Baasch
<br />2 SEX
<br />Female .
<br />a DATE Of DEATH. /9oab Day. TWIN
<br />June 10, 2003
<br />a- cT• AND STATE OF EARTH *rota, USA. nameFlasl,y)
<br />Grand Island, Nebraska
<br />5a AGE - LW BirMay
<br />Mai 64
<br />- UNDER 1 YEAR
<br />TINDER 1 DAV
<br />6. DATE OF WON Newt Day WO
<br />October 10, 1938
<br />MNS
<br />DAYS
<br />• 7- SOCIAL $EOINTT:Y Nl1MBE0
<br />506 -40 -1331
<br />9a- PLACE
<br />OF DEATH
<br />NOSTA 0 "nw" C"C" ❑ "wa�°N�•
<br />121 ER OtaDaAMa X RNtlMKe
<br />U °OA ❑ °°° s°""`
<br />SD FACKITV - Name /enN s,aM andntalMaO
<br />3180 South Blaine Street
<br />Ac CITY TOM 0R LOCATION OF DEATH -
<br />Grand Island
<br />ad INSIDE CITY UNITS
<br />Yes X No ❑
<br />9e COUNTY OF DEATH
<br />Hall
<br />9a RESIDENCE -STATE
<br />Nebraska
<br />911 COUNTY
<br />Hall
<br />9e CRY. TC OR LOCATION 90 STREET AND NUMBER 90Hudn,2i0Cdae,
<br />68801
<br />Grand Island 1 3180 South Blaine Street
<br />9e INSIDE CRY LIMITS
<br />YaaE Na ❑
<br />10 RACE - Ica. 10059 Saxe . Amnon Moan.
<br />at.11E0atayl White
<br />11. ANCESTRY is g. Mahan. M.alcmt. Garman. alcl 12. ®MARRIED ❑ WIDOWED
<br />soeety) Danish ■ A NEVER E D [I DIVORCED
<br />13 NAME OF SPOUSE /#o* gmm naeel
<br />Bill Baasch
<br />fa.. USU*LOCCUPATItk1 ,Gweko01 rtabmaFesgmost us HNDOF BUSINESS INDUSTRY
<br />Nao,4ag Mr s ' 1M1 '�
<br />Bookkeeper � Bill Baasch Welding
<br />45 EDUCATION 1S,eubonk4 s9lgra0ata111dalap
<br />EMngnW0 rsdary 10.121 COaege na050 /
<br />12
<br />TS FATHER - NAME FIRST MIOOIE UST
<br />•
<br />Edmond Van Trump
<br />r7 MOTHER
<br />FIRST MIDDLE - MAIDEN SI1NaAME
<br />Alice Reinecke
<br />la WAS DECEASED EVER N US. ARCED FORCES?
<br />(1100 8aank.) 1 PI yea owe waramdas055155161
<br />no I .
<br />199 INFORMANT - NAME
<br />1 Bill Baasch
<br />1911 INFORMANT MAILING ADDRESS (STREET OR R.F 0 140. CITY OR TOWN STATE. 2491
<br />3180 South Blaine Street, Grand Island, Nebraska 68801
<br />20 EMBALMER• SIGNATURE& LICENSE NO
<br />7 ,� �
<br />210 MEn4OD OF DISPOST/DN
<br />❑ +a ,
<br />0 Dona �
<br />210 DATE
<br />June 14, 2003
<br />21c CEMETERY OR CREMATORY NAVE
<br />I Grand Island Cemetery
<br />22a. FUNERAL NAME
<br />• Apfel - Butler- Geddes
<br />❑ Cremation ❑ Dena""
<br />21d CEMETERY OR CREMATORY LOCATION 0,00 OR TOWN STATE
<br />Grand Island, Nebraska
<br />Zb FU05004. HOME ADDRESS ISTREET OR R.F.0 NO CCTV DR TOWN, STATE. ZIP)
<br />1123 West Second Street, Grand Island, Nebraska 68801
<br />23. iMMEDIATE CAUSE TENTER ONLY ONE CAUSE PER LINE FOR , 31 tel. AND (di M 'o& 11 !wr.n 012501 WW1 09905
<br />PRT
<br />A
<br />' ql mu! Fr- 5t,I5� -GM ua"G approx. 2 weeef.
<br />■ DU T O.OR AS A CONSEQUENCE OF 1rye+Y / oelwe01 onset bra Beam
<br />111) fr©cgressr tic. s b�arfi � d me el tr ci, ;approx. 5 Cfe-tr S
<br />DUE TO. ON AS A CONSEGUENCE OF - Mler5ai between away and beam
<br />!CI
<br />OTHER 3IGN.FICANT CONDITIONS - Commons coan3W lo IPM death n not reined
<br />PAR'
<br />A DID, h U perm s i ran, froi d disease
<br />PART no IF FEMALE
<br />�GNANCY IN
<br />(Ages 10 -54/
<br />WAS THERE A 1 23 AUTOPSY • 2 WAS CASE REFERRED TO MEDICAL
<br />THE PAST 3 MONTHS" EXAMINER OR CC11 ER'
<br />Yes n No ( Yes R NO in Yee n No 6Q
<br />HOW INJI IRY OCCURRED
<br />26a. f 2011 DATE OF INJURY ago Day PP)
<br />❑ Accede. ❑ unnemon,ne,
<br />2ec HOUR OF INJURY ! 260 DESCRIBE
<br />M 4
<br />❑ Swede ❑ Pemmnq
<br />Homicide In,egai�on
<br />❑ ❑
<br />26e INJURY AT WORK
<br />Y66 NO
<br />❑
<br />261 P LACE OF INJ - At Ime4. rare: srcet Moto, 1
<br />ce abla t i
<br />1
<br />26g LOCATION STREET OR R F 0 N0 ;ITV OR TOW% STATE
<br />AVID
<br />NYKMSA WARY
<br />q0.00.0 6 4 ai
<br />27a DATE OF DEATH i60 Dar Y•)
<br />June 10, 2003
<br />26.1 DATE SIGNED !AM Da 1,1
<br />20G T/ME OF DEATH
<br />M
<br />2711 DATE SIGNED /Mb Day Y, I 2 7c TIME OF DEATH
<br />tee - 1 Z 2 4073 17:45 M
<br />b 'i i
<br />211c PRONOUNCED DEAD ELM Day. 1
<br />2ed PRONOUNCED OEM3 eeme
<br />M
<br />270 10 me tMm o1 my k de weed a ... -, a • 0Pete and do0 to toe
<br />ca 0140 5/ 0/ 004. _
<br />I atom and Tae I .
<br />. .
<br />. -
<br />280 O^ me Ways d e,31103lron and M 8 V05110$00 , m my o0ngn Beam Occane0 a<
<br />me eme date and place an: aue /0 me 21/50is. 319500
<br />''Sgnasre ano Tine, 9•
<br />29 DID TOBACCO USE CONTRIBUTE DEATH' 30 a HAS ORGAN OR TI -
<br />II YES Cr NO 0 UNKNOWN III
<br />. , NATION BEEN CONSIDERED I I 3011 WAS CONSENT GRANTED'
<br />055 1g NO ` 0 YES It NO
<br />1
<br />31 NAME AND ADDRESS OF CERTIFIER NHYSICAN. CORONER S PNY5ICIAN OR COUNTV ATTORNEY, T oe p,,,,,,
<br />Steve Rusen M.D. 2116 W. Failley Ave., Grand Island, NE 68803
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPifrki 4EN OF.'HEAL'TH ANb
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF TOVRIGIN,4L REtiORo ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN S;! AL,RPCORDS. ,,
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.'
<br />DATE OF ISSUANCE
<br />APR 1 5 2008
<br />LINCOLN, NEBRASKA
<br />STATE OF NEBRASKA 201$061.98
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SERVICES PI ARM"
<br />VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />06952
<br />1
<br />STS �, E.Y '� irOPER'
<br />0,- ,95SISTANT• ISTRAf ,
<br />� 1 MENT Of 141 T7 A�II.
<br />1MAW';5.lES 1
<br />320 DATE FILED BY ijE /STR 0 2 y
<br />
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