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<br />STATE OF NEBRASKA
<br />8
<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, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />7/24/2017
<br />LINCOLN, NEBRASKA
<br />STATE OF NEBRASKA- IIIPA&T(P OF WAL B MID HUMAN SERVICES FINANCE AND SUPPORT
<br />VITAL STATISTICS 02 07829
<br />CERTIFICATE OF DEATH
<br />., LAST 2 SEX Te C LIEATH Nr. JaeF Y•
<br />James Earl Keeshan Sr. Male 1 June 29, 2002
<br />I TV AND.4fA1 •OF DAlTH alvrn E1SA naD1, milli 5o. AGE - Lug tummy UNDER 1 YEAR UNDER / DAY 5 DATE OF on,' Abe" Om WW1
<br />rm., rlos , DA '.: - ""S February 28, 1935
<br />Omaha, Nebraska 67
<br />saveme IE *E 'Ise. PIACEOF DEATH .... _ .. .
<br />508 -36 -3854 I AIOSPIrAL t�
<br />TO Team. Nave 0 R ems= ame:drl ❑ ER°i
<br />St. Francis Medical Canter ❑ DOA
<br />B11: INSIDE CITY tans 1 M COUNTY: OF DEATH
<br />1 Yes UNo ❑( Hall
<br />Rd STREET AND NUMBER eareekvID Cede1
<br />2208 Cottonwood 68801
<br />TL'TTI :iQiYh OR 4..,Y/TIGI OF "EAT" - --
<br />Grand Island
<br />,A RES'.} um • STATE 9P MARY
<br />Nebraska 1 Hall
<br />Ts Teta MEN NNW Amman MOM 1 11. ANCESTRY leg. mum M n. ex¢, Comm acl It v Mf
<br />M" mite i , American ( ❑,, P ` D
<br />Mt USUAL OCCUPATA:M /Cr.M NON MT* POW Prey Nat? ( '4b WNO CF BUSINESS INDUSTRY
<br />Of.FE At ,..ARti-' ..
<br />Owner /Operator 1 Keeshan Trucking'
<br />FIRST /ADDLE LAST r 17 MOTHER
<br />Alfred
<br />2208
<br />13 INA5 DECEASED EVER IN U ARMED FCFC,F_S?
<br />Yet. ne a1,kj le yes: cm war AM MPH ol Lemon;
<br />No
<br />TUNE a UCEJIE NO.
<br />.
<br />ROME ADDRESS (STREET OR RFD. NJ.. CITY OR TOWN. STATE ZAP)
<br />1123 West Second, Grand Island, NE 68801
<br />DUE TO. OR AS A CONSEQUENCE OF
<br />41
<br />201705897
<br />u DOLE
<br />,IONS - CoUM Wn SAbeerg lo Me deal, dA nog
<br />t1,
<br />fATT
<br />Sc CITY. TOWN OR LOCATION
<br />I Grand Island
<br />Keeshan' I
<br />13a' b*ORMANT - HALE
<br />Mary Keeshan
<br />(ENTER ONLY ONE CAUSE PER LINE FOR ■3I ■bl. AND HS
<br />indPnOrrs,
<br />BOX OF
<br />:: vES gJ NO
<br />FAST
<br />STANLEY COOPER
<br />ASSISTA STATE REGISTRAR
<br />DEPARTMENT HEALTH AND
<br />HUMAN SERVICES
<br />WIDOWED 13 NAME OF SPOUSE d/ ode. thusWo M?MFMl
<br />,,,,o Mary Ann Vetick
<br />15 EDUCITION FSRLWF NM* WHO ire ahoOMPO ...
<br />Florence
<br />PART II P FEMALE WAS THE% A ! 2< AUTOPS•
<br />PREc*ANCY IN Tiff, PAST 3 !AC
<br />OTDBP ❑ 14"4 Hose
<br />❑ D.w
<br />EimueenTerceeery D312!
<br />Ceae,e :l I b l •
<br />{MALE MAIDEN SURNAME
<br />Kelly
<br />•
<br />M h AtN
<br />263. DATE OF INJURY IMO. DIY Yr./ 1 25c HOUR OR
<br />25e INJURY AT WORK 126' ONCE EE 101- I I U 15 J /wR la 1 WeAl natlT 250: I STAWET OR N F D NO (II r OR TOWN
<br />Yes f ND (fl
<br />2.6 TIE OF DEITH
<br />ATE OF DEATH (MT Onv H..) 283 DATE.SF0'NED ,ME DIr Y.'
<br />6 -29 -02 ; W ,
<br />275 DATE SIGNER /No OR F ! 270 TAME OF DEATH 1 260 WIGSIO rNCCD DEAD Kt OR Yr;
<br />01;22 A.M.
<br />Cured et 2me es* ANI Cane MC 150, REV S 1 266 -C.ne bee eweeseen And O Ol.IW5MO,L N In, awe' ewe•
<br />OW IM doe AV DACE WO due b re CNAMEN IMO
<br />r . S.,. ana 74310
<br />3C D PAS CONSENT URA •e
<br />0 TES
<br />• 2b PRONC„NCEO DEAD
<br />JUL 1 0 2002
<br />I se 060E ORYarts
<br />vas E.:p°
<br />MAILING ADDRESS (STREET OR RFD NO_ CITY OR TURN, STATE ZIP(
<br />Cottonwood Grand Island, NE. 68801
<br />� y 21i METHOD OF DISPOSITION 1 215 DATE: 210 C£IETERY OR CREMATORY HAVE
<br />C!/. '� e / [ sow 0Re.e.AI July 2, 2002 I Grand Island Cemetery
<br />22a fUNEWLL • HALE f 210 CEMETERY OR CREMATORY LOCAT>OPS GTY OR TOWN STATE
<br />A:nie1Butler- Geddes ❑�°"°'' ❑ ' 1 Grand Island, NE
<br />r13.vai Whom onset MG Xa,
<br />WRACD:
<br />.11 WMIII 01E03 WAY
<br />23 HAS CA-SE REP MC YaBENN AL
<br />� Exhume - A C A
<br />A5et !OD Yes LI ND. `' Ye. I 1. s o A Z7 Ye;.
<br />2EQ DESCAME RCIP INJURY OCCURRED
<br />i
<br />M I-
<br />STATE'
<br />7 -02 -02
<br />1 Tow P k. F
<br />ChRe' s ;T40
<br />3313 T ay,
<br />OD TOBACCO USE CORT+REJTE Tr THE DEATH j X T `1AS ORGAN OR 1ISSUE DONATION BEEN CONSIDERED
<br />kZI TES ❑ EID ❑ UNKNOWN
<br />31 NAME AND ACOSESS CF CERTIFIER ,PHYSIC!AJI, CORONEN S:NYSICIW OR COUNTY ATTORNEY 0,0eo.. AIM
<br />Thomas Warn r M.D 2444 W. Faidley Ave., Grand Island, NE. 68803
<br />SS DA IF FLED 95 /EGISTMP ,413 {o, rr. .
<br />
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