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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT
<br />CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD
<br />ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES,
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />• DATE OF ISSLIANcE
<br />1/13/2017
<br />LINCOLN, NEBRASKA
<br />411' DECEDENT -NAME NEST PADDLE LAST
<br />• Gloria Eiwanda Eddy
<br />-- kACE-(941-. WAIN. Meek. Araericaa OIRGIN/DISCITITH.g., MIN*, Maricao, NOE -Lea SINAANy
<br />ispocify) Cimblfifffi Spr i COO 53
<br />ATE OVEIRTI ho U.S.A., CITI *11 0* WHAT COU MASHED.
<br />Sr:1 Nebraska 11 S A
<br />SOCIAL SECUOITY MAIM • ? luso of II)
<br />• 12. 506-28-3325 13a
<br />CITY, TOWN OR LOCATION OP NAM INSIDE CITY LIMITS HOSPITAL OR OTHER INSTITUTION -Noma 10 ea* in saber. * ITOTT OR inn". Indio" inOn•
<br />No(INNIA. Us or ) give afteat cubit otwabiN) 0ANNINNIasr. Sm. Impeder lYNNS0
<br />lei.Grand Island .:Tetl 14e Lutheran Memorial Hospital , Ester. Rm.
<br />INSWENCE -.STATE COUNIV 'I7! TOWN oe. LOCATION SUSUMU) NUmAER INSIDE COY UM(TS ..
<br />Ik Grand Island 1, N. Howard
<br />is jogifigm yiy NW ,
<br />LAST MOTHEe - MA NAME MST
<br />I IrP iseNebrataka Ia. Hall
<br />FATHER- NAME
<br />‘, Edward
<br />wAsomfAsE0 EVER IN U.S. ARMED FORCES?
<br />An. siN •Ni anus wmoim)
<br />IS. NO
<br />SUSIAL. Comm:Sion. ItAsevol DATE
<br />10, 1982
<br />• A alkt
<br />.-SIGAIATURE ENS 110.
<br />1
<br />•
<br />.44
<br />NAM ( Day, r.)
<br />April 7, 1982
<br />PATE SIGNED (Mo.. Day. Yr.)
<br />r 2 *, April 7, 1982
<br />• Tads baN1 of gm imeMoope. Am* Nomoi •■•
<br />sommed mufti
<br />234136NNANN God 111.) 111.) NAME AND ADDRESS OF CERTIFIER (PHYSICIA, cowman IAN OR COUNTY ATTORNEY) (Type et Prin4)
<br />Dr. Gary Sett'e M.D. 906 N. Howard, Grand Island
<br />26a. SysaNNAIP
<br />UNAEWATE CAU ENTER emu ONE CAUSE UNE FOR (a), (b). AND (cm
<br />SEQUENCE
<br />C V 4
<br />DUE 70.0* INCE OR:
<br />(4
<br />IT
<br />ALOODO, WOOL
<br />PMICUIO INVENICATION:(SpoNly)
<br />IONI.
<br />41UIFIr AT WOW
<br />iFfOrify 1 No$
<br />•
<br />301.
<br />USUAL OCCUPATICL (GN:kiad of.rk *me dia
<br />a • fir.. am. g noima) "g A _ SP4ESS OR emoun si COUNTY OP DEATH
<br />twits Domestic
<br />HOUR OF DEATH
<br />23c. 10:50 P.M.
<br />1
<br />ami ft omo
<br />NowilmoiNi deNA Net so Nimmel
<br />DATE Of D*41(157 (A Coy, Fr.:
<br />30b.
<br />PLACE OF MANY - M 1..., 1..., hem One,
<br />N.111.. WARN". No. (Epocay)
<br />STATE Or 11131RASKA-OEPARTIAIIIT OF II1ALTII
<br />SOINEAO OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH /
<br />SEX
<br />2 Female
<br />Fuller
<br />NOLO OF (141(157 (141(157
<br />wIDKE
<br />D (Specify/
<br />PA t rritat : A ■,: cy f tirL ; rt 3MAtEran s mi
<br />Yes No
<br />Laura
<br />VITAL
<br />STANLEY COOPER
<br />ASSISTA STATE REGISTRAR
<br />201704 DEPARTMENT HEALTH AND
<br />HUMAN SERVICES
<br />82 04570
<br />DATE Of NATO (AU.. Day, Tr.)
<br />April 7, 1982
<br />DATE Of OHM Mo., Du. Y.1
<br />May 7, 1928
<br />UNDER 1 YEAR UNDER 1 DAY
<br />MOS. ; DAYS HOURS
<br />66. 6c.
<br />NAME Of SPOUSE (, vim .0314. Acme)
<br />ii. Dale Eddy
<br />Hall
<br />11a.
<br />24b.
<br />17
<br />INPORHAPH - NAME- RELATIONSHIP - A1AIUNG ADDRESS HMV OS LCD. NO.. CITY 011 Innwis IMIHM
<br />IMMV a
<br />19.NRIO Eddy Husband 2131 11. Howard Grand Island, le.
<br />CEMETERY OR CREMATORY- NAME LOCATION CI1Y OLITOAVN STATE
<br />20c. Westlawn Memorial Park 20d. Grazid Islastd, NeIrraska
<br />FUNERAL NORM - NAME AND ADDRESS 4570?? OR RED NO-. an OS H. STA11. ON 6880
<br />fel-Butler-Geddes 11287W. 2nd Grand Island„ Se.
<br />y,
<br />DEA
<br />LAST ...
<br />Nuun
<br />111
<br />• I I
<br />i , FOOP4OUIOCEL1 DEAFJ) 110,40Ut4CED DEAD (Dion
<br />(AID., Day, Yr.)
<br />El . 24c. 24d. II
<br />' lig Ow ohs book of eimAgAilAss ef,fifffl ielsolipoliak, ia my spiNs y. dos/14 iiomioN1 EA
<br />A• Noy, /No end pasta ..d 4... Is A. cooloAl.FooNA
<br />24A. IStemetwee ead 114.1 Ulm
<br />NE. 68801
<br />REGILTRAP. (Mai, DAT, Yr.)
<br />:4 /
<br />losynnol ioN000 Aro owl Alma
<br />imigetto.4
<br />; ik.At
<br />IsserNi batons. r ..• ANNA
<br />CtrtdaK
<br />K
<br />*AS cc
<br />70 CM.
<br />(. Via Or
<br />*WORST
<br />(Spocify Tao or 14o)
<br />22 No
<br />1 INSCIMIE Row Rouser occu1*10
<br />m I 304
<br />LOCATION EISEET 0111 ILF.D. No. CflY 01 TOWN *TIME
<br />30g.
<br />
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