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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMANSERVICES
<br />SYSTEM, ff CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECQR&OffT1tff-A1TH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTIQ& *f1 &IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />MAY 10 2000
<br />ASSTS
<br />LINCOLN, NEBRASKA HEALTH AND HUMANSERV7CES
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<br />90,0003983
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<br />STATE OF NEBRASKA - DEPARTMENT Of NMTm
<br />BUREAU OF VITAL STATISTICS 80 10407
<br />CERTIFICATE OF DEATH c -.21.t,
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<br />DECEDENT -NAME FIRST MUDDLE
<br />De 10hoy, Y'j
<br />Vivian Darlene Schwieger
<br />12. Female
<br />i3. September 23. 1980
<br />UNDER
<br />RACE -(e.¢, Wkile. ORIGI ESCENT (*.a.. WAkw. Mwk"' A -1.0 R+wVq DAYsl"oults;
<br />a wmm* V*4 -A�1410r�^.OkJ SP-4)
<br />Aums:17.Aug. 12, 1924
<br />4. 0 MY S. American 1,' 56 Lb.
<br />CITY
<br />C
<br />CITY AND STATE OF BIRTH I.$-A., CITIZEN OF WHAT COUNTRY MARRIED, NEVER MARRIED, NAME OF S►OUM (i � wft. Spi.0 �;do A
<br />WIDOWED, 0 (Specify)
<br />"�*R=tings, Nebraska U.S A. 110. Married Herbert
<br />vt;'
<br />& Schwieger
<br />SOCIAL SECURITY NUMBER USUAL OCCUPATION (G-� kind of work '*" d,,4,9 moo
<br />KIND OF BUSINESS OR INDUSTRY
<br />COUNTY OFDIEATH
<br />*fwwk;qd"e'o"A;IrwF--^4)
<br />506-28-1201 or Beautician
<br />1 I
<br />Cosmetolc
<br />1140.
<br />12.
<br />130.
<br />13b. )gy
<br />Hall
<br />C"T, T(YXH OR LOCATION OF DEATH
<br />WSIDI CRY WAITS
<br />HOSPITAL OR OTHER INSTITUTION - No"
<br />"OSP
<br />10 OR MOT. - a.
<br />Crand Island
<br />(Specifty" or N.)
<br />V es
<br />vim
<br />tre 7 M
<br />Memorial Hofs
<br />6p"-# (S*-Oy)
<br />I .
<br />1!4x-RESIDENCE
<br />14c.
<br />Ildl'u an ital
<br />I:Enatient
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<br />-STATE COUNTY CITY, TOWN 01 LOCATION STREET AND NUMBER INSIDE CITY MtUT�S
<br />'.
<br />sp�io�7*4 or NO)
<br />Ij..LNebra ska 113b. Hall Koenig
<br />15C. Grand Island M. 2408 W. Koenig Y es
<br />I
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<br />FATHER - NAAAA FIRST JAIDME LAff-jJ* fREft-"DEN NAME FIRSF
<br />Joseph -- Rhoades _ j7. (Liv.) Mae -- Richardson
<br />V(Dec.
<br />WAS WAS DECLUED EVEN IN U.S. ARMED FORCES?
<br />(VON ed ds. o
<br />INFORMANT - NAME - RELArocmimo - ASAILING ADDRESS (SM117 On R.P.D. Ko OR zw)
<br />ti
<br />I& No
<br />,.Mr. Herbert Schvieger-Husband-2408 W. Koenig-MaJ Island
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<br />Sept. 26,
<br />CEMETERY 00 CREMATORY -NAME LOCATION CITY 01 TOWN STATE
<br />Burial Imb. 1981o,.
<br />Grand Island Cemetery_12w. Grand Island, Nebraska
<br />FUNERAL HOME -NAME AND ADDRESS (STMET OR 110. NO.. CITY 00 TOWN. STATL ZIP)
<br />-S"ATUM A UCENSIF NO
<br />PAO
<br />122.Apfel-Butler-Geddes 1123 W. 2nd, Grand island, NE. 68801
<br />ToOfte-b" of -y bo.4odge. dj-** 16"' 4010 Pk" --d ft - 0. bek W, -wt- ..= P "-ao
<br />dft �d place -d 4.* :0I=
<br />)�7
<br />M000ftle "d rJOW111-07 24a. Mo-two ..d T;*.) 111h-
<br />A
<br />DATE 0 (Me., D", Yr.) C SIGHW(holo. D.-y, r. I DEATH
<br />1HOUR 7ATH
<br />236- P,
<br />23c. M vi 24b. 24C. M
<br />DATE CWDIAtH 45M. Dvy, Yr.) .218 PRONOUNCED DEAD PRONOUNCED DEA6(-P4..,)
<br />V
<br />040" Der, Yr.)
<br />23d. z I
<br />KAAQ AND A IFI NN (PHYSICIAN, CONONERS PHYSICIAN 02 COUNTY ATTORNEY) /Type «►riM)
<br />a. C.D. McGrath M.D. 729 N. Custer, Grand Island, NE. 68801
<br />11900111" DATE RECEIVED BY FG13TRAR (Me., Doy, Y,.)
<br />;�- 01. 2- 1 I
<br />.
<br />...1010MIXATE CAUSE Nltft ONLY ONE CAUSE PER LINE FOR (0). (h), AND (0)
<br />6
<br />DUN TO, i% ASA CONS9QUINCE OF: -4
<br />DUN TO, 04 AS A COMMENCE OF,
<br />PAC O•44 94WOCA00 CONWW0-d-C...W- -owWoloo I. d..o bw.N r.&.*" PAO 18, W FE"" IWAS CASE Ittli D �Yo MIID�K^k�
<br />PREGNANCY," TA WAS THERN A AUTOPSY
<br />N PAST 3 MONTHS? (Spocit, ar NeJ VIAMNIN 04 C0400*4
<br />Y&S 0 SP-41, T-
<br />ACCIDINT. SLOCIOL HOWCIDL Uww.
<br />am MINIM* IWOUTI"w" 120094)
<br />I DATE OF RUURT (AG., Day, T•.) HOUR
<br />1309.
<br />OF 11'QUITY
<br />103103dc.00l mow *U UNY OCCURRED
<br />300* .1 �
<br />30b.
<br />1A
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