|
Lot 1, Block 3, First Addition to Cairo, Hall County, Nebraska.
<br />-
<br />--
<br />THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUW -4N-SERVICES-
<br />SYSTEM,
<br />IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECON&D3AflkLE. W- ff `
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS S�G`FIU #CH l
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />JUN , 900004873 A .EY Fik,_ _
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN BFRVI I EGiE M —~
<br />STATE OF MMURA- 0VARTUM OF NMTH pp
<br />NMW V WTAt STA""M C) 0351,9
<br />CERTIFICATE OF DEATH
<br />FIRST
<br />hoom LAST UK
<br />DATE — A (Ma•, DoT. Yr.)
<br />m
<br />n
<br />C1
<br />e•B•• RNT (e.g.. lMakew. –lal/ BST Y
<br />Mll.w.ki( oft.) (SPOON?) and DAY=
<br />�w�ite
<br />o
<br />C->
<br />Dutch 84 •
<br />? ct 21
<br />( R!N IA U. .A..
<br />�`Yut�f
<br />CITIZEN WHAT
<br />I.. WlDOweaolvoRCeo(so . eHT,
<br />NAME ( w•i RM wq 111.w 1101M)0
<br />n
<br />rn>
<br />LL Pearl Klin cek
<br />SOCtAI SECURITY NUMBRR U AL CU ►ATION (GM kinl �wrri �M /vNllR wM KIND OF BUSINESS OR INDUSTRY COUNTY OF DEATH
<br />C=)
<br />o
<br />I ri y I.
<br />INSIDE CITY tWUTS NOSFITAL OR OTHER INSTITUTION – Home (Knet;* siAer, M 0060 of n.$I DOA.
<br />Grand Island
<br />f7
<br />C1
<br />z
<br />,
<br />z
<br />c
<br />c D
<br />a -,
<br />N
<br />m
<br />_ � Y
<br />rn
<br />N
<br />'�
<br />rn
<br />p
<br />c�
<br />C
<br />.��
<br />-n
<br />N
<br />rn
<br />CO
<br />C=)
<br />—.7
<br />CD
<br />O
<br />Lot 1, Block 3, First Addition to Cairo, Hall County, Nebraska.
<br />-
<br />--
<br />THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUW -4N-SERVICES-
<br />SYSTEM,
<br />IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECON&D3AflkLE. W- ff `
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS S�G`FIU #CH l
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />JUN , 900004873 A .EY Fik,_ _
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN BFRVI I EGiE M —~
<br />STATE OF MMURA- 0VARTUM OF NMTH pp
<br />NMW V WTAt STA""M C) 0351,9
<br />CERTIFICATE OF DEATH
<br />FIRST
<br />hoom LAST UK
<br />DATE — A (Ma•, DoT. Yr.)
<br />Clinton -
<br />T`heodore Van Winkle male
<br />March 1 198
<br />e•B•• RNT (e.g.. lMakew. –lal/ BST Y
<br />Mll.w.ki( oft.) (SPOON?) and DAY=
<br />�w�ite
<br />DAY DATE OF BIRTH (AAe., DoT. Yr.)
<br />HOURS.
<br />Dutch 84 •
<br />? ct 21
<br />( R!N IA U. .A..
<br />�`Yut�f
<br />CITIZEN WHAT
<br />I.. WlDOweaolvoRCeo(so . eHT,
<br />NAME ( w•i RM wq 111.w 1101M)0
<br />.Center, Nebr
<br />U.S.A. , . married
<br />LL Pearl Klin cek
<br />SOCtAI SECURITY NUMBRR U AL CU ►ATION (GM kinl �wrri �M /vNllR wM KIND OF BUSINESS OR INDUSTRY COUNTY OF DEATH
<br />It 508--44 -6774 a.«I "�.a'
<br />I Farmer A
<br />CITY. TOWN OR LOCATION OF D"TN
<br />I ri y I.
<br />INSIDE CITY tWUTS NOSFITAL OR OTHER INSTITUTION – Home (Knet;* siAer, M 0060 of n.$I DOA.
<br />Grand Island
<br />(Spew? Y« w N.l B� Ih.M elll Mleli�rl
<br />, ee St. Francis Med
<br />O�ryer«w /f.e. M . Iw..aewl (!►«dr)
<br />Centel
<br />RESIDENCE -STATE COUNTY
<br />,
<br />n
<br />CITY, TOWN OR LOCATION STREET AND HUMERI INSIDE CITY twm
<br />`T�. Nebrask Hall
<br />Ise. Cairo ISr. 502
<br />Alexandria iswe'yr « «N.,
<br />_ � Y
<br />es
<br />..�- ..vim._ .— r.,... ,n,vuc iAyT
<br />Alonzo unk Van WinkI117, Lenora u
<br />WAS OKL49D EVER IN U.S. AWMQ FORCES? INFORMANT– NAME – RELATIONSHIP –MMUNO ADDRESS (ST8E11 W 1 D. NO. CITT Of TOWN. STATE. Eery
<br />(Tim. we. of WA) W Te% fiw war mod Aries wI a e)
<br />Pearl VanWinkle- wife- hr 6
<br />to RR a
<br />CEA%FTM 01 M- A
<br />CITY OR TOWN STATE
<br />me. • Burial Imb. 3/5
<br />SSMASMRR– slcNAruRE LICENSR NO.
<br />. 1
<br />Tt OF DEATH (Aft.. Dq. Ye.)
<br />"a. Me., C
<br />DATE Tome Met d
<br />eawe(a r.eeA.
<br />U, I FUNERAL HC
<br />1, fRU5`
<br />1 ADDRE33 (STMET OR R.LD. NO., CITY OR TOWN, STATI, Eery
<br />ral Home Wood River Ne 68883
<br />T• r.) POWN OF DEATH
<br />ire. 2M. M
<br />►RONOUNCEDDEAD ►ROOUNCEDDEAD(Nevr)
<br />[[[[ f (MA.. Day, Yr.)
<br />24c.
<br />Ow r» bars of ONW00011ew 0-41•r MwMi�wMew, iw M
<br />v " floe, Awle awl Pie" sod /w 1. I►e s..wsl slel r. w'""e" IoM «s.rn.e el
<br />�E
<br />24*. (Slawelrn wwI TIMeI
<br />ON-
<br />- ---- � srn.art . •%owimewa rnrarllAre WE L%MPRIT A41LM 2T) flip or Irtw() I
<br />23. Mark E. wicz, MD, 908 N. Howard Ave, Grand Island NE 68801 1
<br />MIC43MM DATE RECEIVED By REGISTRAR (M..,
<br />►ARi A U31 (ENTER ONLY ONE SE PER LINE FOR (e), (b), AND (c)) IwoM .w..l ewr*
<br />(� 1 Massive crebrovascular accident (stroke)
<br />� w
<br />DUE TO ST
<br />J� vNacwcrRC OF. i IwM.al ►eMew ew.el .wr dee�A
<br />Arteriosclerotic heart disease and vascular disease.
<br />DUE TO, OR AS A CONSEQUENCE OF, Iw+en.l iel.eew ew,e1 sod heM
<br />{'_ W
<br />'-'►ART T C – C.w/Uiewe sewrf►w4R w Aew1A rM web r3lewe/ ►ARI IM. M /lMAI1, WAS THERE A AUTOPSY WAS CAI! tl /f1R30 TO MEDICAL
<br />j M FRlr z.,K Me TIN PAST 3 MONTHS? 000-i(T Tew Sr "AAUNEY OR CORONIR
<br />i �AVrI(I/1i Yr « Nel
<br />Yes Nab
<br />ACCIDENT. SYICIDL HOMICgE, tINORT., DATE OF INJURY (Me., DoT, Tr.) HOUR OF NUURY ' DESCML 110'W INIURT OCCURRED
<br />$11011, 30b. 02 PlMDeefA 11WlSTIOATIOIe. (SpeilTl ti�
<br />I
<br />
|