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STATE OF NEBRASKA -DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH,,
<br />201905190
<br />DECEDENT NAME FIRST MIDDLE LAST
<br />1 Eldon Thaddeus Stobbe
<br />SEX
<br />2 male
<br />DATE OF DEATH (Mo., Day, Yr.)
<br />3, November 8, 1983
<br />RACE-(e.g., White, Block, American
<br />Indian. etc) (Specify)
<br />4 white
<br />ORIGIN/DESCENT (e.g., Italian, Mexican,
<br />Gorman, etc.) Specify) Cr
<br />s. unknown
<br />AGE -Lost Mohair,
<br />(Yrs.)
<br />6a. 58
<br />UNDER 1 YEAR I UNDER 1 DAY
<br />DATE Of BIRTH (Mo., Day, Yr.)
<br />7. October 16, 1925
<br />MOS. : DAYSHOURS i MINS.
<br />6b, I6c.
<br />CITY AND STATE OF BIRTH (11 not in U.S.A.,
<br />na me c unhy)
<br />e AST2ton, Nebraska
<br />CITIZEN OF WHAT COUNTRY
<br />9. U.S.A.
<br />MARRIED, NEVER MARRIED,
<br />WIDOWED, DIVORCED(Specify)
<br />10, married
<br />NAME OF SPOUSE (If wife, give maiden name)
<br />11. Lillian Peters
<br />SOCIAL SECURITY NUMBER
<br />12.506-22-6839
<br />USUAL OCCUPATION (Give kind of work done during most
<br />of workingIdol. even if retired)
<br />130. rick Layer
<br />KIND OF BUSINESS OR INDUSTRY
<br />13b. Construction
<br />COUNTY OF DEATH
<br />14o. Hall
<br />CITY, TOWN OR LOCATION OF DEATH
<br />14bGrand Island
<br />INSIDE CITY LIMITS
<br />(Sparily Yes or No)
<br />IA, yes
<br />HOSPITAL OR OTHER INSTITUTION - Name Of nal in RAAATH.
<br />give street and number)
<br />14d.VA Medical Center
<br />1f HOS► OR INST. Indicate DOA,
<br />Ctetpet(enr/toter Rm . Inpotiont rsp«dy)
<br />14.. Inpatient
<br />RESIDENCE -STATE
<br />130Nebraska
<br />COUNTY
<br />13b. Hall
<br />CITY, TOWN OR LOCATION
<br />Is3rand Island
<br />STREET AND NUMBER
<br />1sd.712 West 13th St.
<br />INSIDE CITY LIMITS
<br />(Specify Yes or No)
<br />1s.. Yes
<br />FATHER -NAME FIRS
<br />16(dec)Joseph
<br />MIDDLE LAST
<br />Stobbe
<br />MOTHER -MAIDEN NAME FIRST MIDDLE LAST
<br />17(dec)Salo Menlo Selliski
<br />� WAS DECEASED EVER IN U.S. ARMED FORCES?
<br />(Yet, no. or enk) (II yes, give ser and dotes of service)
<br />16.Yes/2�•5-44/2-26-46
<br />INFORMANT -NAME -RELATIONSHIP -MAILING ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN, STATE, IIP)
<br />68801
<br />19.Mrs.Lillian D. atobbe.wife. 12 w l3th,Grandlsland,NF
<br />`
<br />BURIAL, Cremation, Removal
<br />20e rial
<br />DATE
<br />20b.Ne . 11, 1983
<br />CEMETERY OR CREMATORY - NAME
<br />2a Westlawn Memorial Park Cern
<br />LOCATION CITY OR TOWN STATE
<br />204.Grand Island, NE
<br />B 1.1a •O. "din'FUNERAL
<br />/,� / ( i
<br />HOME - NAME AND ADDRESS (STREET OR 1.1.0. NO.. CITY OR TOWN, STATE, 541)
<br />22. Livingston -Sondermann, 505 W. Koenig, Grand Island, N:
<br />,2
<br />li
<br />Y1983
<br />_
<br />uril
<br />.21To
<br />e
<br />DATE '• •EATH (Mo., Day, Yr.)
<br />i v To b. Completed by
<br />) CORONEYS PHYSICIAN,
<br />I' et COUNT' ATTORNEY
<br />enly.
<br />DATE SIGNED (Mo. Day, Yr.)
<br />240.
<br />HOUR OF DEATH
<br />24b. )A
<br />PRONOUNCED DEAD
<br />(Mo., Doy, Yr.)
<br />24c.
<br />PRONOUNCED DEAD Moor)
<br />24d. M
<br />ATE SIGNED (Mo., Day, Yr.,'
<br />23b. November 14, 1983
<br />HOUR Of DEATH
<br />23c. 7:25a. M
<br />On die boas of nomination and/or investigation, in my opinion bath occurred et
<br />the time, dote and place and due to Me coawp) dated.
<br />24e. (Signotkore and tido)
<br />Hte best el my knowledge. death «cone • ill!, time, dote end place end dee to the
<br />.aaso(s) stated. G D / 1 `� / (�
<br />,��s..a ., f,� �( t sr v
<br />23d.ISigneran and TWO BteX /'� _ }__._ _...._._.. _..... �.,.._...,
<br />NAME ANO ADDRESS Of CERTIFIE (PHYSICIAN,
<br />2. E
<br />REGISTRAR
<br />26a. (Signature)
<br />27. IMMEDIATE CAUSE
<br />PART
<br />e, Hypercalcemia
<br />/I-
<br />NTER ONLY ONE CAU E PER EINE FOR (o), (b), AND (c))•
<br />68801
<br />26b.1
<br />Interval between onset end death
<br />Days
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />(b) Carcinoma of the esophagus
<br />DUE TO, OR AS A CONSEQUENCE Of:
<br />(c)
<br />PART OTHER SIGNIFKANT CONDITIONS -Conditions contributing to death but not related
<br />11
<br />Pneumonia
<br />PART 111 1f FEMALE, WAS THERE A
<br />PREGNANCY IN THE PAST 3 MONTHS?
<br />Yes ❑ No O
<br />AUTOPSY
<br />(Specify Yes or No)
<br />28. No
<br />•
<br />i
<br />Interval between onset end death
<br />Months
<br />Interval b«wen onset and death
<br />WAS CASE REFERRED TO MEDICAL
<br />EXAMINER OR CORONER
<br />(Sp«ilyv,u or No)
<br />29. NO
<br />ACCIDENT, SUICIDE, HOMICIDE, UNDET.,
<br />OR PENDING INVESTIGATION. (Specify)
<br />30e.
<br />DATE Of INJURY (Mo., Day, Yr.)
<br />30b.
<br />HOUR Of INJURY
<br />30c. M
<br />DESCRIBE IIOW INJURY OCCURRED
<br />30d.
<br />INJURY AT WORK
<br />(Sp«if y Y« or Nal
<br />30..
<br />PLACE Of INJURY - At home, Form, sheet, fo.tery,
<br />office building, et. (Specify)
<br />30f.
<br />LOCATION
<br />30g.
<br />STREET OR R.F.D. Ne. CITY 09 TOWN STATE
<br />t r_.
<br />WHEN THIS COOY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF -HEALTH, IT CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />1 BUREAU OF VITAL --STATISTICS, WHICH IS -THE LEGAL DEPOSITORY FOR
<br />- ytT ORDS_.
<br />\-1;7.e(
<br />Issued November 30., 1983
<br />ASSES AN Ik!RECTOR OF HEALTH LINCOLN, NEBRASKA
<br />
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