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Franctional Lot 6, Fractional Block 132, Union Pacific Railway
<br />Company's Second Addition and it's compliment: Fractional Lot
<br />6, Fractional Block 5, John Voitle's Addition, City of Grand
<br />Island, Hall County, Nebraska.
<br />TOP
<br />WHEN TFMS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AMP -41;0
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL _ 4W FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAM _- fl N "ICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />MAY 5 2000 400 R
<br />T ~ Tf tAR
<br />LINCOLN, NEBRASKA HEALTI# 1 S`EM
<br />200004697 ff
<br />STATE OF NEBRASKA - DEPARTMENT OF FIEALTII
<br />Bureau of Fits) Statistics 7 A
<br />CERTIFICATE OF DEATH, _
<br />DECEASED -NAME .•t1 -51 5ER 'DATE OF DEATH r •0.100. RAI. a.1 r
<br />U--- Cte nnlentta 7 Male is October 12. 1975
<br />wof. , ._,.. u•Met• o..A- - DATE OF $4M ...0..00. D... ; COUNTY OF DEATH
<br />ACE'Ww", r•RRo...IR00cw,.,R..r, AGE -ut. .
<br />.of_' w.t wvf I .
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<br />Fb Grand 7. �g� Ft Francis Hos ital
<br />STATE p BtRM r. rfpT ». w t.•....r1 UT,ZEN OP WHr1T COUNTRY MARRIED, NEvER MARRIED, UR` 1VING SPOUSE ,,� - »r 0,.f -01 ..oat,
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<br />Is d I!t Yes If. 12 E. kith St.
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<br />FATHER -NAME •.Mr rrOM1 a.fT Mott -"- MAIDEN NAME ••ftr r.pp1 ufr.
<br />ISO William Stoppkotte ts11 Mary Sundermeier
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<br />PF PART I DEATH WAS CAUSED SY (INTN OM r ONE CAUSE PER 1041 FOR fnj. Ibl. AND f, P _
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<br />Franctional Lot 6, Fractional Block 132, Union Pacific Railway
<br />Company's Second Addition and it's compliment: Fractional Lot
<br />6, Fractional Block 5, John Voitle's Addition, City of Grand
<br />Island, Hall County, Nebraska.
<br />TOP
<br />WHEN TFMS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AMP -41;0
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL _ 4W FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAM _- fl N "ICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />MAY 5 2000 400 R
<br />T ~ Tf tAR
<br />LINCOLN, NEBRASKA HEALTI# 1 S`EM
<br />200004697 ff
<br />STATE OF NEBRASKA - DEPARTMENT OF FIEALTII
<br />Bureau of Fits) Statistics 7 A
<br />CERTIFICATE OF DEATH, _
<br />DECEASED -NAME .•t1 -51 5ER 'DATE OF DEATH r •0.100. RAI. a.1 r
<br />U--- Cte nnlentta 7 Male is October 12. 1975
<br />wof. , ._,.. u•Met• o..A- - DATE OF $4M ...0..00. D... ; COUNTY OF DEATH
<br />ACE'Ww", r•RRo...IR00cw,.,R..r, AGE -ut. .
<br />.of_' w.t wvf I .
<br />Yhit�— « It '
<br />Fb Grand 7. �g� Ft Francis Hos ital
<br />STATE p BtRM r. rfpT ». w t.•....r1 UT,ZEN OP WHr1T COUNTRY MARRIED, NEvER MARRIED, UR` 1VING SPOUSE ,,� - »r 0,.f -01 ..oat,
<br />WMOWED. D
<br />DrvORCED .
<br />_ -- '
<br />»o M•n, r"... N,..w.
<br />IE "
<br />"-- _
<br />Is d I!t Yes If. 12 E. kith St.
<br />1« I
<br />FATHER -NAME •.Mr rrOM1 a.fT Mott -"- MAIDEN NAME ••ftr r.pp1 ufr.
<br />ISO William Stoppkotte ts11 Mary Sundermeier
<br />,. WAS DECEASED EVER IN U.S ARMED FORCEST jV INFORMANT - NAME - RELATIONSHIP- MARENS- ADDRESS Ina, o• R • o .O . Cn• O• - 3•
<br />R•ti AR• - ..•....t M r..- 11••'11 .- .-I I.•.• .....•.t
<br />,,. M. B
<br />..M -•
<br />PF PART I DEATH WAS CAUSED SY (INTN OM r ONE CAUSE PER 1041 FOR fnj. Ibl. AND f, P _
<br />is
<br />!ol �
<br />tbt N
<br />,rrrsun uvt! r-, ;a ro. a •f • <o..YW1•CI pW .- __..- ____._ ____.__ __._ ._- .
<br />NAh,bp r00I u00RN
<br />tT,.O CARN MAtr
<br />►ART R 07.t11 SgM►KAMT CONDITIONS CONpTtONS CON1f11RyY"G TO DEEM OUT NOT 11rLA11D PART tlt If PI EA". ,HAS 1-1111 A � AUTOPSY �IF YES rr.t r� O Of CO.
<br />TO CAUM GNEN M ►ARV W PRtoft WT WE MC PAST I rrONT.t/ o
<br />ACCIDENT, SUICE, HOwCK/t,- ATf t+a.•- a.. ...f, N
<br />NOW II 1Ti URY OCCUR11ED 'I-"- I
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<br />PA _ 1 nb O ' O
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<br />INA)" AT WORK PUCE OF INJURY •, .o..f. ... f•Mn_ .K•CMq L
<br />LOCATION .11.11, O! t , a ..o . C1. o. to.. PAR ,
<br />11Nc,a H► C» .0. ONK1 rRR . 1rC ' f•lC,n i
<br />!',rand Islands Nehraska
<br />,«
<br />I% !
<br />CEVWICATION -- .O.r00 .+• 11.0 .o•r -. D.. •1.0 ..o utt yr - Alit ur•! o. Oro /oro -0t •».+ ,y I1 A•- OCCv11.10
<br />►NTSKIAN: TO r
<br />. _ 7
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