|
givoegt
<br />��Rggil i �ti�I4$Ir$ 5`
<br />! r�gtiI
<br />a4A »Z.
<br />I1
<br />yy � 1
<br />�Irii,�3f//y,iZeY4�)) 0$11" / i1'Ig✓•r�m `aZ�a11.1.U.11,/,/yl,3u 6nlaQ�� I ASI,O:e/dai:ONIJII/lllbt ati..,AlOtigi iT0/k$aWdelait`a�ll`,
<br />i
<br />TI5Yddddla ;. °SId�9Y11NEI�a` �r,SYddDaa. -,.
<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 />10/2/2020
<br />LINCOLN, NEBRASKA
<br />i•
<br />DECEASED --s!...... rias.
<br />I.. Thelma..
<br />RACE », 1100110. AN{SICAN INOYM, .
<br />ITC. ' I !r[cln I
<br />•
<br />202007694
<br />84.4c4,7karria
<br />Sarah,BohoenIump.
<br />ASSISTANTISTATE, REGISTRAR
<br />DEPARr'MENTIOFIHEALTH
<br />AND HUMAN SERVICES
<br />MATE`OF NEBRASKA DEPARtMENT Or'KEALTH `
<br />' .':Burean of Vital:Seatiiiioa
<br />CERTIFICATE OF : DEATH
<br />'AGE—usr
<br />NnNbA, I
<br />Se 41
<br />.. White
<br />CITY, TOWN, OR LOCATION OF DEATH
<br />Grand Island
<br />SLATE OP VON IIP NOT IN U.S.A., NAME
<br />COUNTER)
<br />.. Nebraska
<br />SOCIAL SECURITY NUMBER
<br />11slne81911
<br />II. Nebraska
<br />' Aa11011 ' . LAN
<br />I,orrai.ne Schwieger
<br />UNRRA I TEA{
<br />INANE. I NT'
<br />Mos:
<br />IS:..
<br />•-s
<br />NOUNS
<br />u
<br />MM.
<br />SEX
<br />percale.
<br />DATE Of SIM 1 NOMI. sr,
<br />TIM I
<br />6
<br />. 'Aug. 2, 1936
<br />DATE OE DEATH I MONTN.4•f., 1,{Aa,l..•
<br />: November .14 X977;
<br />COUNTY OF DEATH •
<br />E.. ' ,B411.
<br />1NSI01 CT. tr7 $
<br />r mels. TES .Oa MO I
<br />,,.. Yes •
<br />CITIZEN OF WHAT COUNTRY
<br />E. USA • ..
<br />HOSPITAL OR OTHER ReSTITUTION—NAME IN NOT IN 11110111. owe swan AND NUNIN I
<br />N; 717 West. Division St.: •....
<br />MARRIED, NEVER MARRIED,
<br />MOOR*
<br />�e4 rTRCED N sown /
<br />ME.i
<br />USUAL OCCUPATION Aum coos o roam DONS OWING Nos. OP
<br />210111110 INE. STEN O wow= I
<br />• Homemaker 9 Q�
<br />I .
<br />COUNTY
<br />IN. . gam
<br />"FATHER—NAME • PINT
<br />OAS•
<br />• Ernest -
<br />CITY, TOWN, OR LOCATION
<br />«: Grand Island
<br />MOON ,AST
<br />Johnston
<br />SURVIVING SPOUSE r N win, Dim omen NAM{
<br />Sohivieger
<br />KIND Of ROSINESS OR INDUSTRY.: .
<br />• Home
<br />STREET AND NINMRR
<br />• IMIDE CITY NNITS
<br />1
<br />SONNY YIS OA 1101
<br />NE. *Yea
<br />MOTHER—MAIDEN NAME
<br />Iw.
<br />PINT
<br />STN. Irene
<br />`$.WAS DECEASED EVER IN U.S. ARMED FORCES! INFORMANT —NAME —Ri&ATIONSMN=MARINO ADDRESS I MN o. I uo..68Poi; !{USAN,
<br />LTM. IMI. N r1IMM.A) R/ fa.. 0... .:r ,.i ArNNP a rm.)
<br />Ila. Leo pohwieg+er-Husband-717 W. Division St.. Grand• :i>tir id,
<br />(EN/ER'ONLY ONE OUSE PER LINE FOR (e), (b), AND Im Aaile me E. ETAS
<br />n RR.WEM OMS{T AN0'NAM.,
<br />717 West Division St ; .
<br />$10011 ' . ' - IAIT: - .
<br />PART I:e
<br />DEATH WAS CAUSED SY:
<br />CONSMONS, Ir ANI,
<br />ANKH OAiE. SIN TO
<br />IMMSOI•TI CAUSE I.1.
<br />STATING ENE UNDER.
<br />LYING CAUSE' WAST
<br />IMN/N AN CAUSE •
<br />INN Suicide
<br />IWE 10, 01 AS • CONYO (MCL Cl, .
<br />1 (b) ' TrIauTina to left ehen+.
<br />1 Ns. MN
<br />02 AS A CONIlo1CI
<br />immediate
<br />KI gun shot wound
<br />PART II, OTNER'.SIGNNICANT COMMONS CONDITIONS CONTIRUIING TO DEATH OUT NO1 MATEO
<br />TO tAUSR GIVEN IN PART R.)
<br />PART NI. II FEMME, WAS.INERE A AUTOPSY M YES WIN 'ft 1110$ COM.
<br />PREGNANCY a1 Tr. PAST I, MONTHS? INS OR MOP SODEN 10 ;DI.IININING CAVES
<br />OP DINH
<br />YES 1i .; alp ISR. NO 116.
<br />HOW INJURY OCCURRED I ENTER NOUN OP INJURY IN PAN I OR PAIS II, INA. IS 1
<br />DATE Of INJURY I RIGHTER, ON, T4
<br />ACCIDENT,SUICIDE; HOMICIDE,
<br />OR UNDETERMINED fine n
<br />REF= tx'►z:.n:iilP>c 11/14/77
<br />INJURY AT WORK PLACE OF INJURY a Nor. max, $Tear, wooer,
<br />Mogan NT: MOI OIYICE woo.. RIC. Nsnorel
<br />110
<br />VCERTI,ICATION— NO/011 UST TEAR
<br />- N►SICTAN•
<br />IN.
<br />NI. hoWe
<br />aI HOUR •
<br />Iw 2: 20am
<br />I«. gun shot wound
<br />LOCATION I STENO 01 N.P.D. NO., CITE W ?VAIN, WAR I
<br />7 7 West Divisi n..4 t.
<br />YW AND 4w SAW MN/NN MIRE ON �i lglam my, row Ni{ DRAIN OCCURRED AT D:P%& f. ON ON
<br />NOMI Mr r1Aa 11 EOM AMR NANI. 1NDUSI LiN A(L,: 116;1114
<br />M YN
<br />1 Ow MYO/D.NgO{.-WE
<br />INTI _ !NO 'Ile !_AS. To AN C HEIR ?ANO..
<br />SIN HOU. W mail TN! NdNNt WAS Ill. . pO 040 ,,��
<br />NOMI DAY TIM :.NOTP
<br />• 20 A M, rn. 1/ 14 I 1977 I. RA
<br />45 A M
<br />i DEonn.cm rine ATE S tMONWE I
<br />Sgt'. Sher:. 0c. // /414-7
<br />CITE OA TOWN -- —
<br />*1ON111 NT
<br />• 1 AMNIONS ME TO •
<br />AU.,. Inchon. Nor ism
<br />CERTINCATION—MEDICAL EXAMINER OR.CORONRRI oN INS OASIS Or
<br />ESAMINATION 06 11111 lOOT ANN/OS TNN INVIIIOAT10N. IN W PINION,
<br />NAM OCCYnn0. 0$ NIM NN ANO DUI To no cameo swop.
<br />QRTIPIER,..-NAME.ton OS noon
<br />•TT. Charles F. Fairbanks
<br />MAILING ADDRESS.,,aer WIER
<br />1' p_ -f_ Ri,4317
<br />*RENAL, CREMATION,' EE AL
<br />. t�SM1lYI
<br />. Burial
<br />DATE )RONINnu
<br />, NAY. t
<br />NMNov. lt;, 1977. !s. L�.Vi2]{i8 �r0 30,�,AweY�Inrann T B:5O�j �r1�iC[Tani uE rt'+y�j 9',�j
<br />EA►MLMER SIGNATURR'IT LICENSE EEGNSTRAR—AGN. DA!. b RY1
<br />.tel les9 11p f''�
<br />slaw on
<br />9015 W nt•7st Ti
<br />IslaTTd :15Th :6$$011;:;
<br />C OO
<br />N ' ' ROS TOWN - Dae
<br />CEMETERY OR REMAT OAY—NAMJ?
<br />„,Grand Island (City)
<br />Ne • Grand Island,.'. Nebraska
<br />FUNERAL HOME—NAME AND ADDRESS 1 Shaw W e.t.a. No.. en. OR EOMI. 1TAII. MY I - •
<br />
|