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STATE OF NEBRASKA
<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 />DATE OF ISSUANCE
<br />09/27/2017
<br />LINCOLN NEBRASKA
<br />. DECEDENT 44MlE (First,. MWOdle,
<br />Loretta Viola
<br />4. CITY AND $TAT€ OR T7:.RRITORY, OR FOREIGN COUNTRY OF
<br />Denman Nebraska
<br />7.500.0L seamy NUNDEFI
<br />508 -18 -7249
<br />8b. FACILITY -NAME (If Oaf inaritu0an, gist xtraet end number)
<br />St. Francis Medical Center
<br />F:.. CSTYOR1D)1 OF DEATH fhrclade Bp Cndc)
<br />Grand Island
<br />ICESSMSTISE
<br />braska
<br />NH3T1UMt£R
<br />03 S. Oak St.
<br />[TILL STATUS 4r TIME OF DEATH '/lierrian 0 Wow Marls
<br />ied, Y+utImpcWd 13 Viewed Cl Dammed 11 sleknasur
<br />STANLEY S. COOPER
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT HEALTH AND
<br />6752 HUMAN SERVICES
<br />20170
<br />1Dh. NAtJE OF $P
<br />aqprA
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<br />tIIbNllgetTECMISF♦FlI
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<br />mrdiIm 1,
<br />our kW
<br />1NCTJa.11512
<br />L filtKlnld*1
<br />tar — e
<br />220. DAT €OF INJURY Ora, Cosy .Y,)
<br />Q YEs 0100
<br />33,i.DA36 OF DEATH PAa, Day, Tr)
<br />.January 7,2005
<br />F3J1TE BIOiO (Ma.. Day, Yr.l
<br />rT nu!. 13,2005
<br />stabs - orlm knnei 641e
<br />dun caw e(s)
<br />9EDAARR 6511IE101PB rya.
<br />SO40NATURE
<br />68803
<br />SA EXU1r`TY
<br />Hall
<br />EI?'$•NAM ( First, MlCtlle,
<br />William Tha(3bert
<br />I s,.EVER Hl U.S ARMED FORCES? elw -0rtei of litts dyes.
<br />garunh.l NO
<br />10I T11000F IMPOSITION
<br />©Wrauo.
<br />Q I3+1OIMmanl
<br />O Oiher Reeresl
<br />1 FNSMOJER-EANOUNS
<br />l &d.CEMETERY,
<br />FUNERAL HOME NAME AND MAILNau^ AODRE$0 ($tW, City arTarpa,$lwo1
<br />pfel= Butler- Geddes Funeral Home 1123 W.
<br />CUE TO, OA AS A GONSEO1I 14CE OFD"
<br />DUE TO, OA AS ACOHAEOUETVCE CF:
<br />DUE TO, OR AS ACONSEOV
<br />e.DESCRIBE NOW Mr OCCUR
<br />OF INJURY - STREET &HUMBER, APL NQ
<br />22c'i OF DEATH
<br />2:37 p m
<br />' MeflmR dabs NM place
<br />ro anaT'sle) V
<br />TH ' @a.AGE-6057 Birthd,
<br />(110.) 82
<br />lest. Sul
<br />Reeder
<br />4. INFCRStANFNAME
<br />Norman Whitt
<br />Ulf R LGCaLTI
<br />2E.a.HA80RGAN OgTIE DONS
<br />UN
<br />PUGEi? DEATH
<br />HOSPITAL ttpalant
<br />BG CITY CRTOWN
<br />itl irterrY DEATN
<br />Naauel 0 Fl00cl59
<br />OAat14of4I0peop E14 141
<br />Lase 0014
<br />Norman Whitten. Sr.
<br />a,P1.A( .0F.INJURV4F, home. fetm,
<br />.. o YES C] 140 0 PROBABLY LiYtJNKNOldN 0 YE$ 3x'510
<br />07. WOE. TOLE ANDAD iEB.40FCER.TEIER Dr1 WSIC1AN.. COFONER'0PHYStAAF Chi CCu ATTORNEY' t'1worPfM(1
<br />Jahiti Wagoner M.O. 800 N. Alpha Ave., Grand Island,
<br />eland
<br />1E0,UOEN9E ND.
<br />J iris
<br />CITY!TOWN
<br />Rosedale
<br />as cMtt'btt',JO'N 1pd darts pArti]tieeawtmalln S+e ur o44sq oeuNghnef In PAIR L.
<br />A DATE SIGNED (MA, Day,Y .l
<br />IP C0DE
<br />68801
<br />2nd, ! Grad Island, NE
<br />PERT 1w EotNrtne66orco 400e940. YgL.tae,9f cem1iderme 4hat dime ccaawdtie DONUTe4W nip Ouch re cerrdes en4m,
<br />retphanMy MrrrrA, ax wl?elcakeMOIMOO Mao& ahAMNN U* eIlaMgy. DO NOT AeFEl TE. Enkrone arm ammo am a IMP.AddadeditauJ Asps rleuvewP
<br />e,71EDIME CASE _.
<br />,] Nur inq HomNLTC 01
<br />1,1 ides, Maiden $Urnal,e)
<br />ilumens Schumann
<br />140. LATI NSHIP TO DEC'.EDENT
<br />Husband
<br />ti )FTRANSPORTATIDN INJURY 210. WAS AN AUTOPSY PERFUME:1.'
<br />01e8ear12ar
<br />Fedestdan
<br />Cater(Spe00,1
<br />.RRCNQUNC DE00 IAS2. Der:Yr.f
<br />10,. DATE Wm, Dry, Yr. 1
<br />F auuary 12, 2t?0
<br />STATE
<br />Nebraska
<br />-.. --• 1TO 0pCode�
<br />68801
<br />24b:TAIEOFOEATM
<br />APPPA)UMATEINTE
<br />2da.C41 Ilebash d ewanilrliam author ia,ext wion, In my rPi rr
<br />the ama 4a14 and plow end due to the s0Ucel5) stated. (Sigfntur
<br />CONSIDERED?
<br />Yb.0548 CONSENT 0R4NTED4
<br />Not Applicable 820aIrNO D YES D NO
<br />¶t pAOIdl'RAR IMa. De$Yx,1.
<br />JAN , t $ 2005
<br />SIVE OF NEBRASKA—DEPARTMENT OF REALTHAND HUMAN SERVCES FINANCE AND SU PPOPT
<br />CERTIFICATE OF DEATH 0 0022/
<br />Sufis) 2. SEX 3.A4TEOFDEATH (iAa..11ey,Yr.1
<br />Whitten Female January 7, 2005
<br />. UNDER t DAY A, DATE DE &NTH (Ma, Day, Yt.1
<br />ems. December 16, 1922.+
<br />
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