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WHEN THIS C'O?Y CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />- DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TQ B,L A, ?RUE COPY .
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DE'PA'6f,ViXli OF - }RMTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAt;'D�Pfl ltOiWAR
<br />VITAL RECORDS. 101707
<br />.':
<br />DATE OF ISSUANCE f
<br />SEP 2 131968 STANIti)Y'.R` ai
<br />o y
<br />LINCOLN, NEBRASKA
<br />IUKAU OF VITAL STATISM
<br />CERTIFICATE OF DEATH
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<br />OW. 011147 -NAME fin? WDD(E WIF
<br />!f1
<br />DA ! Of DEATH (AM., Dry• rn.J
<br />Eva Iva Sagesser
<br />Femal
<br />September 11;.,;1988
<br />RAC! -ro I.. While. RTAr1,
<br />Fr•IiM, Moittn. AGE -tw @.Am" UNDEt 1 r t' UNDEN 1 *AT
<br />DATE of gtTrt(iw -, ttr o. /
<br />` )[e ,`')
<br />�� "i e"rT n rr�) 87 s. oar Noun; AuNS.
<br />Sept. 11, 1901
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<br />Ciff AND STATE Of SIM IN two #a U.S.A.
<br />CITIZEN o/ WHAT COUNTRTMAptpMyl
<br />"FFVIRt�MtMERP,
<br />NAME OF SPOUSE (Mwife, She I&* new")
<br />"'�"eyail� County, Nebr2�bca
<br />U.S.A.
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<br />COUNTTOIDEATN
<br />506 - 22-64'1
<br />';� '`'i�'ema c'tL�' 1131a Domestic
<br />Hall
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<br />CUT.TOWNORIOCAT79N01FO 'N
<br />INSIDECITTUTAITS
<br />HOSPITAL OROnIEt1NSTITUTf)N- memoOf"tie•irA•r,
<br />ON" 011MIT Y�«•r•pO•.
<br />Grand island
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<br />Sees
<br />R.Mr Sa r.Nrl C1rr,•tYr
<br />Francis Medical Center
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<br />Inpatient
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<br />E901INCE -STATE
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<br />CITY. TOWN 04 LOCATION
<br />SYREETANDNUMEER
<br />INSIDE cm I[ is
<br />Nebraska
<br />Hall
<br />115, Grand Island
<br />404 E. 12th
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<br />MOWER- MARDIN N 1 M10011 WT
<br />Charles Louis Tyre
<br />Sarah Lavilda Hull
<br />WAS DICEASED EYES IN U.S. ARMED FOICESt
<br />INFORMANT -NAM! -. RELATIONSHIP - MAILING ADDRESS 0114111 OR Of 0 "0. CFO b TOWN. SIATL NPR
<br />;; ..o ) (M to. w,.•.- SaA «Na.trwweN
<br />Sagesser =Son -404 E. 12th -Grand Island, NE. 6880
<br />,Wilmer
<br />sUl'm Cf.M•tiM, Rt
<br />t. 14, 1988
<br />C1ME1ERr OR C]EMATORY -NAM!
<br />LOCATION CITTOR TOWN STATE
<br />- 'Burial
<br />Grand Island C�;��aeter y
<br />Grand Island, Nebraska
<br />AIURE i NSE NO. 2. 0 �,j
<br />FUNERAL HOMt -NAME AND AOa5Ud5 (11181111 01 t/ D NO. CITY CM TOWN.IiATR. fin
<br />�20fel-
<br />Butler - Geddes 1123 W. 2nd, Grand Island, NE. 6880
<br />VAM OF MAT" (A r, rr.)
<br />DA Y# 5110.1D (Al.. NY, t.) HOUR OF WAY"
<br />September 11, 1988
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<br />•�►jONOU�N
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<br />DATE SIGNED (AM.. Der. Yr) DEATH
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<br />9 -12 -88 :3•. 4:15 P.M. M
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<br />ADORl� M Of YSICIAN, CORONER s ► IAN OR A ORNlIt) Ilpo m Iri«r/
<br />Jainas V_ Re z. M.D. 2444 Faidley, - Grand Island, NE. 68803
<br />usmrw to ! Ecelveo f,Y R! ISTRAR ;Mo o•r. rt.) —
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<br />PAari A CAr�i( ENJER ONLY CAUSE PER ONE (0). ), AND (())' natal A•w••w 0"0 Said .Iwo.
<br />'.r Cardiac Failure
<br />A EFou OI, I.w w) behave •awt cad do"
<br />ui Gastrointesti.a:al Bleeding F 1 day
<br />W lit PO, on Al A CONSIOUENC! CAS). , rar•.rN A•avw •.M •M I•.O
<br />Septicemia - Sm�:ce Unknown
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