|
LEGAL DESCRIPTION: Lot 230, and the North 28 feet of Lot 231, in Belmont, an
<br />Addition to the City of Grand Island, Hall County, Nebraska.
<br />WHEN THIS COPY CARRES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERT1FES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL- WC00 -0,�i ,WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS19Ct X-"JCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />OCT 1 8 2000 ASSIMNT STATE RE ?*AIR
<br />LINCOLN, NEBRASKA 200009379 HEAL HUMAN TH AND N SERVICES swSTBN
<br />STATE OF NE&%%W — DEPARTMENT OF HEALTH
<br />CA BFIC OF; 92 12993
<br />1, DUXMW - NAAIE FIRST N3001,E LAST 2 SEX
<br />Merk Al 1 n I Male Novem r
<br />ATE Of TN IR nd n v xa, WiAi oa4e'Y1 50 - -1.1M 6 DATE OF BIRTH IA a Vt IT.v v s&j
<br />(y *! SM EGOS DAYS & n0UN9 Mt' S
<br />Loup City, Nebraska 33 E Au �)st I 95
<br />0 WVPWM FA 0,M is I DOA
<br />507 -90 -4792
<br />!0 FACAITY - "O.W II nOf #00kam r" ssaa/YM nInWm)
<br />1 Sc ;:ay TOWN OR LOCATION OF DEATH na tNS10E CCTV IIMITS y �OUNfY OF 0EA7H
<br />M
<br />Grand Island tial2
<br />k .STATE ob COUNTY
<br />=
<br />D
<br />j ISBN Yes c. Not
<br />Grand Island 9?�_ -!i _81~QS_ AYg.____i_ es__...___.
<br />�,, fRY Is y.li4Yt A1ea.aen. Ga1� et {, 12. YARfa6b NEVER MARP9E0
<br />6ka I>t- jW Wbft ftct AAtetgen M•Ogtl. t l NAYS OF - �M iYe es (s++ n5l fMr tt'Yi
<br />lm,ANCIEST
<br />f White Polish
<br />�!_�'"'DDwEO DnrrRCeo ;sa. It,
<br />�
<br />M
<br />IIA
<br />�.
<br />USUAL OCCUPATION (AIYF An14 d e6ry ROrte Aunq aloel
<br />a, 1 0a*, a.**4 nI 6y
<br />_Mi
<br />rN. WINO DO 9UA`%[SS WOUSTM i — c0� u�AT�
<br />Farm Laborer 'A�
<br />E ?enW:SAry c• SeccsYmtaY .DJIt .. i,uAwp l.i y
<br />Agriculture 6 kl
<br />P OTHER WW CA14T COND$Tk*.S - CwWoomi, c".U" b a"M Om",eletaa PART 6I ¢ FEMALE. WAS THERE A
<br />l2
<br />M fATHER . IIAYF. Pi16T' MroaE
<br />LAiT t 7 AIU(HEA MAgEV hAAlf FIRST V•bOL.E a A,5',
<br />o
<br />h U'
<br />-C:)
<br />----- --
<br />:f. N`spNYA'NT .NAVE AWI�NC Aa.?1lERS 167REET nn f No. -,I � TQyly. �'p�/�t
<br />French V * �`fC. OrfOVd
<br />No ---------------- -
<br />20A
<br />(�
<br />r1
<br />Z
<br />Burial November 14
<br />�r.
<br />1991 Ever Teen Cemetery C_ir.y. Nebzask
<br />n
<br />S
<br />260, INUU11Y AT "OOK 12K PLACE OF KAM - At AmIM, IN-N ,vast tunry, 260 LOCATION STREET OR N f D. NO
<br />ISpeew ✓on or Mal Onto OLWO19. et ap") - Ave .
<br />CD
<br />G
<br />N
<br />fT1
<br />nt DATE of DEATH AM. D6n Yi)
<br />=
<br />rn
<br />D
<br />N
<br />N
<br />approx.
<br />s
<br />11- 25 -92: ' ,* ,
<br />11:00 A
<br />��
<br />n
<br />z
<br />-i
<br />2Ba PROROINM.,ED DEAD iHw)
<br />�
<br />11-10-92
<br />8 :50 P
<br />S. 276 6.1 OeM d ^M MtaMAaOEo. Melt OatumO M 61e feM, 0oN Ana taet.'e w Ouop 6N o 1
<br />ii
<br />no.. Dn 6r bee's d "SMO mn W W
<br />n'AT awe 0cw.led a! �-
<br />a
<br />pyge�,i a1MeA- $$ O
<br />TI Mte. QAb w wam 10 V*
<br />w T 1P.
<br />w TAe
<br />.
<br />-< o
<br />30. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />300. WAS
<br />GRANTED?
<br />-.O YES O NO WKNOWN
<br />❑ YES
<br />'A no
<br />^ YES —
<br />31, NAME AM ADDRESS CERTIFIER fPNY CORONERS FHYSICAN OR COUNTY ATTORNEY) (TYPO m P-4
<br />—
<br />Ellen L. Totzke, a County Attorney,
<br />W
<br />-n
<br />FA -
<br />ae
<br />324 .DATE FILED BY REWTRAR AM, VIM Yr)
<br />o
<br />CD
<br />Z
<br />CD
<br />CD
<br />M
<br />rn
<br />0
<br />Q
<br />N
<br />r—F
<br />c
<br />Q
<br />O
<br />O
<br />D
<br />--3
<br />W
<br />—J
<br />�'�
<br />N
<br />(D
<br />CD
<br />Z
<br />v
<br />LEGAL DESCRIPTION: Lot 230, and the North 28 feet of Lot 231, in Belmont, an
<br />Addition to the City of Grand Island, Hall County, Nebraska.
<br />WHEN THIS COPY CARRES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERT1FES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL- WC00 -0,�i ,WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS19Ct X-"JCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />OCT 1 8 2000 ASSIMNT STATE RE ?*AIR
<br />LINCOLN, NEBRASKA 200009379 HEAL HUMAN TH AND N SERVICES swSTBN
<br />STATE OF NE&%%W — DEPARTMENT OF HEALTH
<br />CA BFIC OF; 92 12993
<br />1, DUXMW - NAAIE FIRST N3001,E LAST 2 SEX
<br />Merk Al 1 n I Male Novem r
<br />ATE Of TN IR nd n v xa, WiAi oa4e'Y1 50 - -1.1M 6 DATE OF BIRTH IA a Vt IT.v v s&j
<br />(y *! SM EGOS DAYS & n0UN9 Mt' S
<br />Loup City, Nebraska 33 E Au �)st I 95
<br />0 WVPWM FA 0,M is I DOA
<br />507 -90 -4792
<br />!0 FACAITY - "O.W II nOf #00kam r" ssaa/YM nInWm)
<br />1 Sc ;:ay TOWN OR LOCATION OF DEATH na tNS10E CCTV IIMITS y �OUNfY OF 0EA7H
<br />422 N. Custer Avenue
<br />Grand Island tial2
<br />k .STATE ob COUNTY
<br />_ _i.,YesY
<br />9t. CITY. TOYYN OR LOCATX)/s +a >'. Rfi T AN0 NUYDEA M.ccadi..6 ,'p C.:USI '" INS�GE Cm tMpTy
<br />'
<br />Nebraska Half
<br />j ISBN Yes c. Not
<br />Grand Island 9?�_ -!i _81~QS_ AYg.____i_ es__...___.
<br />�,, fRY Is y.li4Yt A1ea.aen. Ga1� et {, 12. YARfa6b NEVER MARP9E0
<br />6ka I>t- jW Wbft ftct AAtetgen M•Ogtl. t l NAYS OF - �M iYe es (s++ n5l fMr tt'Yi
<br />lm,ANCIEST
<br />f White Polish
<br />�!_�'"'DDwEO DnrrRCeo ;sa. It,
<br />�
<br />M
<br />IIA
<br />cried _ I Audrat, A
<br />—� c Z,, I ff,
<br />USUAL OCCUPATION (AIYF An14 d e6ry ROrte Aunq aloel
<br />a, 1 0a*, a.**4 nI 6y
<br />_Mi
<br />rN. WINO DO 9UA`%[SS WOUSTM i — c0� u�AT�
<br />Farm Laborer 'A�
<br />E ?enW:SAry c• SeccsYmtaY .DJIt .. i,uAwp l.i y
<br />Agriculture 6 kl
<br />P OTHER WW CA14T COND$Tk*.S - CwWoomi, c".U" b a"M Om",eletaa PART 6I ¢ FEMALE. WAS THERE A
<br />l2
<br />M fATHER . IIAYF. Pi16T' MroaE
<br />LAiT t 7 AIU(HEA MAgEV hAAlf FIRST V•bOL.E a A,5',
<br />�--- Ronald Jerome
<br />°iontkowski kiUw a F x a S c h n. s e
<br />j ti WAS DECEASE D EYf. W U8 AR1*D FORCES
<br />I rraa ir. « wt.1 6� p► 9n+ w ra sr6s a +wwewt
<br />----- --
<br />:f. N`spNYA'NT .NAVE AWI�NC Aa.?1lERS 167REET nn f No. -,I � TQyly. �'p�/�t
<br />French V * �`fC. OrfOVd
<br />No ---------------- -
<br />20A
<br />- - - -- Audr Piontkowski 109 S. Greenwich .Apt l09, Grand 1s lan—,d
<br />RentoM. 12k* CAT
<br />20c. CEYEIERY OR CAEMATQAY - NAYE 20O LocAVON-
<br />Burial November 14
<br />�r.
<br />1991 Ever Teen Cemetery C_ir.y. Nebzask
<br />EAIBALAAEA •• E,,I(�NA(T'�UR� LJC@IEE NO ^// [E'—'
<br />L - -, AnA Q liter Qf,j 3
<br />_ _��Loug
<br />22 FUNERAL II0ME • NAME AND DRESS —� ISTAEET 00 A F 0 NCOT �Y ON.TOWN• STATE. I+It
<br />t- nI ... ._S_1
<br />�? �w=n.CAUlE ONLY ONE CAUSE s•ETi Lo1E FDR IaL ITW. ANO tc0
<br />14-
<br />Au`nnat eaesem a.w1 w OeM
<br />'.,Carbon monoxide "asphyxiation
<br />—0F
<br />Unknown
<br />NSEQU
<br />DUE TO, OR AS A CONSEQUENCE
<br />_
<br />-
<br />see" aesoaee' 1W w Oseeu
<br />CR O. ORO. AT A CONSEOUIN!" Do '— _
<br />� Eck
<br />Mwral owsw� air[ w tlaalA
<br />P OTHER WW CA14T COND$Tk*.S - CwWoomi, c".U" b a"M Om",eletaa PART 6I ¢ FEMALE. WAS THERE A
<br />+ METYCH
<br />A PREGNANCY
<br />724—AZUT:O-�PS—V
<br />It' THE PAST 3 MONTNV Yq 7. h" ! rt R OR CO 04"
<br />Yes �J Np N O
<br />I eSp.aY Yaa Aw Y e S
<br />36a ACCIDENT. BIACIOE: HpAYL^10E UNOET.. 260. DATE Of INJURY AM..Der, "'I Zia HOUR OF W10 Y
<br />I
<br />260 DES(; M HOW M/;URY OCCURRED
<br />-- —'
<br />OR PEND" INVESTPUTOR Moscow
<br />pp
<br />a11100�
<br />Suicide 11 -10 -92 A,
<br />Self - inflicted
<br />260, INUU11Y AT "OOK 12K PLACE OF KAM - At AmIM, IN-N ,vast tunry, 260 LOCATION STREET OR N f D. NO
<br />ISpeew ✓on or Mal Onto OLWO19. et ap") - Ave .
<br />CITY OR ipNT STATE
<br />No Home 422
<br />N. Custer, Grand
<br />Island, NE
<br />nt DATE of DEATH AM. D6n Yi)
<br />20a DATE SIGNED IAA> OM, YlJ
<br />Ab T111E OF DEATH
<br />approx.
<br />s
<br />11- 25 -92: ' ,* ,
<br />11:00 A
<br />a
<br />Z70 647E S1011EC. /Ma 00,. Yrl 27c. TIdIIE Oi DEATH +
<br />26c PRONOUNCED DEAD JAM. OrY, rv!
<br />2Ba PROROINM.,ED DEAD iHw)
<br />�
<br />11-10-92
<br />8 :50 P
<br />S. 276 6.1 OeM d ^M MtaMAaOEo. Melt OatumO M 61e feM, 0oN Ana taet.'e w Ouop 6N o 1
<br />ii
<br />no.. Dn 6r bee's d "SMO mn W W
<br />n'AT awe 0cw.led a! �-
<br />a
<br />pyge�,i a1MeA- $$ O
<br />TI Mte. QAb w wam 10 V*
<br />w T 1P.
<br />w TAe
<br />.
<br />2" d0 TOMCCO USE CONTRIBUTE 70 THE DEATH?
<br />30. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />300. WAS
<br />GRANTED?
<br />-.O YES O NO WKNOWN
<br />❑ YES
<br />'A no
<br />^ YES —
<br />31, NAME AM ADDRESS CERTIFIER fPNY CORONERS FHYSICAN OR COUNTY ATTORNEY) (TYPO m P-4
<br />—
<br />Ellen L. Totzke, a County Attorney,
<br />PO Box 367, Grand
<br />•
<br />Island, NE
<br />FA -
<br />-
<br />324 .DATE FILED BY REWTRAR AM, VIM Yr)
<br />
|