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WHWHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBMSKA STATE
<br />..•T4;J
<br />DEPARTMENT OIL 11PALTH, IT CERTIFIES THE BELOW O HE A TRUE COPY
<br />OF AN ORIGINAL. RECORD ON FILE WITH THE STATE DF:PARtmENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS 711E LEGAL DEPOSITORY FOR 90--106518
<br />VITAL RECORDS. ! i
<br />DATE OF ISSUANCE Adt4l
<br />-
<br />SEP Z5 STANLEY S. COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />STATE OF K WASKA- MAIITMM 01 HIALTIO Q e
<br />BUR air VITAL STATISTICS 87 Q 819 GJ
<br />CERTiRCCATE OF DEATH
<br />OtCDD,NT -NAAtt firif IL OL DATt 00 OWN (Ms. O,r. Yr 1
<br />Paul Jose h Hitdh Les- i male a July 1. 1987
<br />DAtt- (.R.Wkiw111«Y. Aft" itaftla .'OtftlNT(.O.l.tl1,..,MMdt,•, AGe -I"RT M•r ul• .In, Al uN0t111oar QATtO+ Dirt" (M*.• Day. Yr.)
<br />1•LA•t Alkd(fNt•►N Ot.�M.M IIfNt1t,1 IY».1 ^. IAOt. DAYS 1NOVq. WNfI
<br />W.MWtA MVNrtHlt -u.a1 1
<br />fteaw, Caw")
<br />91 • 1169 1110. M. a r•w•.,1
<br />tt 712 -12 -5941 113, Clerk .0- 1 13b Railroad 14o Hall
<br />CITY.TOWNON LOCATION O,OWN INUDe CITY W AILS NQ$f•tTAtOR0111111 INf11tuT10N -NWW fit- tl••.+A•r. 10 "op as wit t.4.0. 00A.
<br />ISP*C,,TMrt«1 Dw,Ifr.Nt•iNwN•) j0 tiP••r.'twv M goa*w.Istw4) r
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<br />29fTDINCt- 15TATI COONTT
<br />CITY. TOWN 011 LOCATION STIRET AND NUMD,11 INS" CITY Iumn
<br />Ifl•tib YM M tN)
<br />Tf. Nebraska 16► Hall
<br />T!\ Grand Islan3 I>r O WT , i If,
<br />A - KAM '91W
<br />LA /ME11 -•LAI N T
<br />(dec) Frank A.
<br />Hitchler dec Dora C. Tagge
<br />WAS OECfAfED EYF IN U i AWlO,C►11ClST
<br />�sf,1� q, !p
<br />IN/ORMANT -NAAIf - 11f(ATIONSTID- MAILING ADDTIO3 W99T, 1lUM CITY ON Wvtk STATC to)
<br />la
<br />(To. •• w NN Ito Tw. $» ••• M h•n N w.w.,
<br />u. es I 4 -23-43 11-14 -45
<br />Mrs M F
<br />SUVAU Ctt.lot(•.. 11seem,
<br />C!M11eDY 011 CteMATORT -NAM! LOCATION IIY 011TOWN S1AT1
<br />�����nl
<br />July S, 1987 !sat Grand Island Cit m Grand Island, Nebraska
<br />2u Burial :o.
<br />So.,. TRINK
<br />D- "ATR IICgMe w s- -- tVN1 Moat -NAM, AND amt* 011 r o NO. C'" 01 1TAt1 "" 68801
<br />� =Livingston- Sondermann 505 W. Koentg,Grand Island, NE
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<br />l M O!A fAM.Ot+,. Yr.1
<br />A N (W r• Yt l NOU11 Or MAIN
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<br />T>. July. 4, 1987
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<br />A (AM.OtY. et NOUt
<br />OlATN
<br />•PIONOUNClODlAO YROWWNCEPPIAPTN•••;
<br />Der. Yr I
<br />�-
<br />ss>w July 113, lHisi
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<br />a
<br />si :� -
<br />_ � a A. Mn N •w a1&.•. w.v. AlwlP,•r w •,Ia N a..• wtTr.., •
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<br />to w Na N w WrMt• I•.w.a..A V. A• •... ••A,1w• •w,.• w the
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<br />"4. fb,.•r•1• •.16•q O..'>'y' r_
<br />NAM1 ANp MrlP% 1 M I ........ \�... a.�...... �v�v..... .. .... -.�• ^� �- - -�._.. _._�_. _ -... .�_ _ - -
<br />rmond E. Metcalf, M.D., VA Medical Center, Grand Island NE 68803
<br />11e DAte 11etelreO BY 11eGMTRAR (M,.. 0.,. Yr.)
<br />fD..f 2" JUL JUL 1 41987
<br />27. UWARIMAIIII VAV (ENYfR ONLY ONE corust PER LINE FOR M. lbe. AND ICA I.r•w1,MwM w•tt •N d•t+A
<br />PA"
<br />Cardiac respiratory .failure
<br />Immediate
<br />Ou —it�c nutN:e or, u't"•'.w..•' w.'.w s.w"
<br />M Advanced aderocarcinoma of lung 1 Year
<br />! To. cw A eONffQUaNCe or: �•"~" `'"°`^'""' •'""'
<br />fd .
<br />j'�wpsR,•NrTaGwtc TIONf- CwOa -r \wtn•w -, .•.w1A t..,v.WV,I �iva.�cr�r�n -�t..T
<br />S. Ap ''Sr.�r�i +ww N•, .tit,MUWC0000M1 rlDtY�r.
<br />Glaucoma _ w s1 no 'S, no 'Isaftop I"
<br />KdOIM•fuIClOt. ttOwdq. Ii "011. DATt at Njun mie.0•,.+rr IrQ10 OP U4WS' 91xt11O now IWO"OCCYtlLO
<br />+ 011 NNo.a NlrtsnoAtaN rs,«.y1
<br />130b sa. '.r ' tad
<br />' PuutT AT tart NAC101 Wluf•r- u Mr. t•.-, \wwl. 1•ettrT ,a'ak- $M11f 011 at 0 w CITT 02011 WN VATE
<br />(t,w1l, ♦w er tai •11.w .•.I..N..w
<br />300 301 IQm
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