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<br /> WiiEN THIS COPY CARRIES THE RAISED SEAL OF THE NEHRASKA STATE
<br /> DFPARTMF.I�T UF HEALTH, IT CERTIFIF«S THE BELOW TO BE A TI�tIE LOPY
<br /> , � OF AN ORIGINAL RECORD ON FILE WITH THE GTATE DEPARTM$NT OF HEALTH �
<br /> - &UFEe1t3 QF YITAL STATISTICS, WHICH IS THE I.EtuAI. DEPQ�YTt�RY�FOit
<br /> VITAL RECORDS. � �
<br /> DATE OF ISSUANCE ,� � ' '
<br /> _C��:
<br /> JAN 19 �99t:� STANLEY S, coarsg�.nuts���'
<br /> ,�...,
<br /> LINCOLN, NEBRASKA BUREAU OF VITAL STATIST�CS
<br /> STATE OFe�URE�11�YRpAI STATIEg�SF MEALTM g�--- 10 Q 43 4
<br /> CERTIFICATE OF DEATH . '
<br /> � DECEOENT.NAME F�R9T M�DDLE U�S► 2 SE■ ID O�TE 0�DE�iH .�fp�n par r�a,� �
<br /> Pa�ricia A. Grubbs Female Januar 5, 1990
<br /> � e�rr�no sT�Te a am� �h�or�u s w KT.eo:��r, sa ,ae•►u�amwa. s w,e o�e�aTN ,u�m o,. �•,.,
<br /> �rn� so uos oarS x NoupS MiNS
<br /> Howells, Nebxaska 58 Au ust 13, 1931
<br /> 1 SGC�AI$ECUPoTI/NUYBEA a+PUCE Oi OE�Tn
<br /> artS ��ny�ra� =ER O��oa�.eni �00•
<br /> 506-30-4854 ' TMEa :Nw�ry�qm� =qy,,.�. :om.,,s„�M,
<br /> • �p FA�Il1TY•f1�nN (Nnq WlrMp�.pr yMf«1p;7urprry �C (',ITy TOWN OR LOCATION OF DEJITN aC IhSipE C�TY UWiS !r COUNh OF pE11TN
<br /> ISpNy YH p�Ipl
<br /> St. Francis Medical Center Grand Island Yes Hall
<br /> 9� HESIDENCE•$TATE 90 COU�'RY 9C CITY.TOWM Oq LOCATqH ya 9TREET 4ND NUYpER �uK.��ZD CO011 9� Itl$IpE CITY LNMtg
<br /> iSach Yw a wi
<br /> Nebraska Hall Grand Ialand 1404 W. John 68801 Yes
<br /> t0 MCE•n p.MnMw Y4ct Mwrcan iro�n n At�f9TRY I�q.�lran.MM■ca�!(M��nan.we 1 �2 �uatnED.NEVER MAS�iuEO l� NIIAIE Of SPOUSE I/�+Y p�n mapn tinrl
<br /> Me 1 lSWCM fSP�cM/ WiDOYlEO-OMORCEO�SpceY�
<br /> White American 0 {� Married Alfred L. Grubbs
<br /> +u uswu occw�na+�tr�.a�a a.aM mr ur��ar ��o unv0 OF sUS�NESS wDUSiar
<br /> W�wfrgrA,�n�nrpl EW�wt�rYaSeconOV►10.iY� CoMp��t-�aSv "
<br /> Homemaker �l`� Own Home q�a � 12th Grade
<br /> t�FATIIEII.lNAIE FIRST , MIDOIE U1ST t7 YOTnEp.4�qENN11ME NIST IADDIE IAST
<br /> .Tohn NI�AT Ulrich l:a�hgri�a �t.� , - It.�t3 ^�:t ; -_
<br />� UWA1pECEl4EDEYERMUS�M1E0CpR�ES� l9MFORW1NT.kAMF•NattlNO+�ODRE55 �STqELT Ai. Hp.pTVppT�lhh.SiAtELtPt �
<br /> IYM.ro.or W 1 fM l�9�v�rv v0 A�Nt d Nrv�cwl . ,
<br /> No ------ Alfred Grubbs 1404 W. John Grand Island Ne. 68801 �
<br /> . l0��V�MI.C�M�MOnii�movY. ZOC OATE 20C CEYETEAYOIiCHEYATORV-NAME �pa IOCATION CrtvOr+TOriM S7A7f
<br /> --- Oa�ran . .
<br /> Burial Januar 9 1990 Westlawn Memorial Park Grand Island. Nebraska -
<br /> � . 2t � R•yGl�ATU11E� SE tq. 2� iUNEA1LL MOME•NM1E ANO AODPESS ISTREET OR 0.F 0 MO.CITY OR TONM STIITE ZIP� �t
<br /> 68801 ,,-�
<br /> � ' r ���y�' Livin ston-Sondermann 505 W. Koeni , Grand Island, Ne. � °�
<br /> T CAU9E IENTER ONIY ONE CAVSE►EN UNE FOR lal.101-AND ICII kwrvy p�1�wn y�s�arq aHn � -
<br /> � m � �t.�,�.,.v,...- " 6 a,,.,a S '
<br /> p!E To.OR�l5�Cq+SEpuENCE • inwvai wM�n o�»�ano aatn
<br /> . � .�--�r.� G.�,�..,.�.,......
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<br /> '►o.o� �COnsEOUEnCE OF �n�«rsi amwn«uN aro aam �
<br /> � _�TME118KiN1F1CrAMf CONpT10N9•COMYO1u Cp�bUMp q 01�py1 np rNaUd CApT 111 li FENAIE.WAS TNERE A Z�A{JTOPS� 25 WIIS CA$Q pEFEpqEU TO ME WCAL 'y�._
<br /> . VAf(I PREOHANCY IN TNE PAST J M�ONTMS+ �SNaI�Y�p Npl E7(ANINER Oq(',qqryER�
<br /> , • Y�f C N09� •�' . lSpt'A'YN O/N0) � .
<br /> Na SUICIOR MOIYCqE UNOET-. 26D OA1E OF�NJI:RY pbAq.r'r� Me HOuH OF Rr 260 OESC�KiE rqri ttalUAV CUpHEO , zr�
<br /> 011�ENO�q1NVEbTIWTqN fSO+�A'/ -..,�
<br /> 2M NINRY AY NpiYI 1K VUCE OF 1WVHY•�t non»,tum.ftNl 4eqry. 26y LOCATqN STflEET OA Q F D NO CRY OR TO�MN STATE
<br /> I�ICIy YA p Nol dUtlOuib�q.Nc fS01C/yl
<br /> � ni OATE Of OEAiN �1b.Oq.rr/ 2Ea O�TE 516NED l�Io.Da�nl 2ap TiME Oi OEATM
<br /> 5 Januazy 1990
<br /> S OATE SKSNED G1�0.DIy.Yr� $7C TIIAE Oi OEATM a�� 2pC CppNOUNCED DEAD i4b,Wr»� 2aE PpONOUHCEO DEAO lMdvl
<br /> ��� 10 Jant�ary 1990 9:35 �€`�
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<br /> �� e to w.ew a nti tno.rep�.awn r n�s�.aw a�+a ar.���o aw o w o 2N.On 1M Das�a M eu�nw4on anG b.�•.es�ga�.o�.�n mv oaNM Ee��n oeev�H�t
<br /> uvw�s)wwe ����/� `�a n»nm�.aa uw ax�aro au�io me ea�s�,s�senw
<br /> f aM TA�� � ���E/ � n�M�an0 Tab
<br /> 2f� DID tOtACCO USE CONTNlUTE TME OEATw� 30a NAS ORpAN Op n53UE DOnATiON BEEN CONSi0EqE0+ ]OD W�S COhSENi Gw�NTEO'
<br /> O YES �0 ❑UNKNOWN :O YES ' �O . �� .--NO
<br /> �t NlYE AND I�OW�ESS Oi CERT�f�ER iVNYS�CAN_COiWHER S PtiY AN pN COUNTY A7TpFHE�1 1TYas o�o�_�_h ,
<br /> S.F. Nabity, M.D. 2444 W. Fai.diey Ave. Grand Isiand, Ne. 68803
<br /> HE6ISTRAp 320 D�TE FLLEO B+oEG�SiqAA iA�o Div n�
<br /> _ _,___ '. ' � J A N 1 6 1990 __,__-_--, -
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