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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 />5/14/2019
<br />LINCOLN, NEBRASKA
<br />201905596
<br />2-4
<br />RUSSELL FOSLER
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />S1 Tt OI: NUR*BKA OEPAII r&O NTOF HEALYW
<br />HUF'1i:AU OF VrFALOTAVSTICS
<br />CER T iF(CATE.OF DEATH
<br />/ADDLE LA11 2. SEX
<br />Arlene Bixenmann Female
<br />97.00847
<br />?, DATE OR DF�iTH f�iz,N PRY bWN--•�•�� .•'• n.u.!lry 21, 1997
<br />I -, .. nnv a 1.. C (M 00,1N (f Ma a, 054 r.anv ncrry/ .
<br />Grand Island, Nebraska
<br />7. SOCIAL
<br />5. ADE • Lai B+•8dsy IUNDER 1 YEAR
<br />UNDER 1 DAY
<br />C DATE OF F:=1;1 -71t ----4.-'77,1a 11. ary
<br />October 11, 1924
<br />roe.) 72 54MOs 1, DAYS
<br />5cHOUH81 �a
<br />SECURITY NUMBER
<br />506-22-3896
<br />Ss PLACE OF DEATH ' - •--
<br />HOSPITAL ] mesesA OTHER: ❑ Nursing H97.0
<br />BQ FACILITY .• New (anct miatr t MgEMN and ranter) -
<br />2027 W. 11th St.
<br />>t CITY. DAN
<br />❑ ER OI en1
<br />0 Dei
<br />a0
<br />II
<br />Reeder*
<br />Dr (•>•,
<br />< OR LOCATk:N OF DEATH -
<br />Grand Island
<br />PE RESIDENCE• _
<br />be.
<br />N51OE C'r.. TY LOOTS -
<br />Yee [j Nm 0
<br />-Se. COUNTY OF DEATH
<br />Hell
<br />STATE
<br />Nebraska
<br />10 RACE
<br />S4 COUNTY - -
<br />Hall
<br />11A CT', TOWN OR LOCATION I Ed. STREET AND NUMBER (ElINdsgl'p Coder t SE INSIDE CRY LSXTE
<br />Grand Island 1 2027 W. 11th 68803 1 y,..171 No
<br />)
<br />• (.0- WAAL BJ . 4"4"Cl l Men
<br />mcpsoloo White
<br />14. USUAL OCCUPATION 1CewiirdaT,art es.A...,..
<br />ii. ANCESTRY f.0. MO. M.*rdot Gomm, t&I 4go
<br />Amer-lcan
<br />se i[i ..........'
<br />IS 4' MARWWED ❑ WIDOWED
<br />D ❑ DVDRCEO
<br />11 NAME OF SPOUSE XII* EXYR w07111 ftEY
<br />Joseph .Bixennnann
<br />aavAAyale /Nn1r,e701
<br />Office Worker n7 Federal Govt.
<br />11 FATHER • NAME FF•ST
<br />Ira �° Hatfield
<br />LAST
<br />SA WAS DECEASED EVER IN US ABED FONDEST
<br />fro . ,f0. W.) I Of WM sw• DAY W dam arsenical)
<br />18e O.FORMANT AWJNO ADDRESS (S,s¢t y OR RFD NO CITY OR TOC O. STATE ZIPI ...
<br />2120 W. Charles St. Grand Island,' NE 68801
<br />I� 15 EDUCATION (SOldfy . 51511.1 grade ra ..TS81sd)
<br />LTQ Fymeetity or Sfnwda,y 13-121 : Caeca De at S H
<br />12 `.
<br />17 MOTHER . FlRST
<br />Margaret -fes.. Wilson
<br />mat MAIDENS SURNA?II
<br />14, INFORMANT - NAME
<br />Mark Bixenmann
<br />211 f kBALUFA - STOIMTTEE C LICENSE NO.
<br />if: 244.4.44.4.1...14//43
<br />291 R WFiLL HOME -HANE
<br />Livingston -Sondermann F. H.
<br />271 LEIDODcE 02FOsrTlON
<br />210. DATE 21c. CEMETERY OR CREMATORY NAME
<br />T23ei,,,, ❑.p„a, Jan. 25, 1997 Grand Island City Cemetery
<br />21 o CEMETERY OR CREMATORY LOCATION CITY OR TOWN ' STATE
<br />❑c IN ❑Oman, Grand Island NE
<br />2E9 FUSE/IAA HOME ADORE55 ISTIEET OR RF 0 NO CITY OR TOWN, STATE ZIPI
<br />601 N. Webb Road Grand Island, NE 68803
<br />CUE 10 ¢1 AR A COwSEOUBNCE OF
<br />AN
<br />Du -710 TOMAS AC AMEd LAKE OF
<br />)✓/TER CNIYONE CAUSE PER LMF FOCI OA AND IO1 ly Interval aeween pre ate seam
<br />3
<br />Wils4CAMT cad:o ase- Gaa,alsee.ELIQ MN fop dt,Ies Male1
<br />4/4464414.
<br />Wean.0 Werw eee
<br />S4Ase Ween,
<br />• saes r.awgrm
<br />77A 7KTi'. C►01.2rM :titr AM nl
<br />1( January 21, 1997
<br />jll EXINE6D71D An Ow Ter 7h,N[fiF DAN
<br />January 21 1997 9:24 AM
<br />La 11,144 v1' 9161TrM mn.'MITI. eau we wets Aro we AM
<br />Wow* Rare
<br />1>tA DATE OFaiWRy RAL DRI Y+1 2e. HOUR OF 'WRY
<br />AI
<br />PART yT W FEMALE. WAS TIEJEA
<br />T)IEOFIAPGY W THE PAST 1 MUNTHST
<br />IAgq IO-Sil Yes n No
<br />2E1 BOORT AT wows I70strew
<br />at
<br />Y..❑ -p
<br />TEd DESCRIBE HOW wow( co.
<br />24 AUTOPSY
<br />Interval EeAreon at sr.':
<br />eleN eet,een 5)5e1 and Ona1A'.
<br />a WAS CASE REFERRED TO MEL.CA.
<br />EXAMINER OR CORONER,
<br />Yes
<br />2fgiIOCAYIDN
<br />Zea DATE SIGNED Ab LM A.. 289 TWE OF DEATH
<br />STREET OR PF D NO CRY OR TOWN
<br />STATE
<br />0112Le. taraw
<br />Alt COAT
<br />•
<br />FROIKATaCED DEAD 148 Day. rr,
<br />r;
<br />8 i I
<br />76 Cn..s 5..s d ..."....N: Ana v ^be9rorl .1 .111q mew, awe, accused M
<br />he ,..t! Ma and Mee•M �. L,ti MANS) via
<br />—..a. - - Swes .era Ti.ra
<br />^i4A / 10-
<br />Ms MASCACIAAO l fl6SAr 006.T10NBQ1NCLWNOEPIISr Mb WAS CONSENT GRANTED,
<br />c36.0,,Ka i ❑ TES 1/29 I ❑ YES
<br />.11067;Ito TisI SP7771Gava 06 WOWS ATTOWNE} I 'TtM1e ArPlM-'bF
<br />281 PRONODNr FD DEAD /Now:
<br />Jr MD :00 Al .
<br />.�, 11..s/ 1%
<br />a, Grand Island Ne 68803
<br />I am DATE FILED B. REDS, RAF 55 (Ary rr.
<br />JAN 277,
<br />01
<br />01
<br />Q
<br />
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