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Kansas Department of Health and Frivironment
<br />Office of Vital Statistics
<br />CERTIFICATE OF DEATH
<br />1. Decedent's Legal Name (First, -Middle, Last)
<br />BONNILEE ROSE SCHNABEL
<br />•2. Sex
<br />FEMALE
<br />3. Date Of Death (Month, Day, Year)
<br />06/26/201.6.
<br />4.
<br />Security Nurriber
<br />:507-34-5214 .•
<br />6. Last Name Prior to First Marriage . •
<br />• WEIMAN
<br />• 7a. Date Of Birth
<br />.10/31/1931
<br />7b. Age
<br />84 YEAR(S)
<br />115-2016-11888
<br />State File NUrnber
<br />5 Date Filed By State RegiStrar
<br />07/01L2016
<br />9. Decedent Ever bi U.S. /anted Force$,
<br />NO ,
<br />Attic. oaunty of Peath
<br />101-INSON
<br />Place Of Birth (City And State OrForeign Count
<br />WEST POINT, NEBRASKA .• ; ••••.. •
<br />10a. Place Of Death
<br />NURSING HOME
<br />10e. City or Town Of Death
<br />OLATHE
<br />11. Marital Status
<br />MARRIED
<br />19b, Facility Name (If Not Institution, 'Street Arid Number).
<br />EVERGREEN COMMUNITY OF JOHNSON COL#NTY •
<br />12. Surviving Spouse (Name Prior to First Marriage)
<br />RI -CHARD SCF4NAGEL9800 WENONGAN
<br />13b. State or Foreign Country
<br />KANSAS
<br />13c. County or Province
<br />JOHNSON
<br />13d. City or Town
<br />LEAWOOD
<br />14. Decedent's Ancestry
<br />GREMAN, CZECK, AUSTRIAN
<br />16. Decedent's Hispanic Origin
<br />NOT SPANISH, HISPANIC, LATINO
<br />13a ReNdence - StreetAddresS:::•
<br />•
<br />. .
<br />. •
<br />YES.;
<br />13e. Zip4de
<br />60206
<br />17. Decedents Education • •
<br />HIGH SCHOOL GRADUATE OR GED COMPLETED
<br />20. Father/Parent Birth Name (first,Middle, Last).
<br />LEO WEIMAN •
<br />22a. Informant's Name (First, Middle, Last) :
<br />RICHARD SCHNABEL
<br />Z3. My.thcd Of Lipcstor:
<br />REMOVAL FROM STATE
<br />25. Funeral Service Licensee And License Number
<br />18. Decedent's Occupation
<br />HOMEMMAKER
<br />: • • :
<br />beCederit's Industry •
<br />• •
<br />21. Mother/Parent Birth Narne:(Flt4,
<br />• .FLORENCE ; • ,
<br />22b.: Mailing Address (Street Number. City, State; And Zip Code)
<br />9800 WENONGA LN, LEAWOOD, KANSAS( 66206
<br />24e. Piece, Of Disposition '
<br />WESTLAWN MEMORIAL:PARK
<br />Zlc Reletionshlp To Decedent
<br />HUSBAND, . ••• • •••••.:•: •••'•.•••••f!'
<br />241, Location ..
<br />:GRAND ISLAND, NEBRASKA
<br />• . • • .
<br />16. Narne,Of Enibalnier And License *mbar • .
<br />PAUL. • M- NORsTRK) 3251.
<br />. , . . .
<br />27. Name And Address Of Firm AMOS FAMILY FUNERAL HOME, 10901 JOHNSON DRIVE, SHAWNEE, KANSAS, 66203 : •
<br />• Approxirnate'Interval:
<br />;Offset TO Dealt!' .
<br />:14114UTES:
<br />:YEAitS .
<br />/WMARK N SMITH.- 2159
<br />28. Cause Of Death
<br />•Part I. Events (diseases, injuries, or coraPlications) that directly caused the death.
<br />IMMEDIATE CAUSE (Final a. CEREBRAL ANOXIA
<br />Disease or Condition Resulting we To (Or As A Consequence Cif):
<br />In Death) b. CARDIOPULMONARY ARREST
<br />Conditions, If any, leading uue To (or As.A Consequence Of):
<br />To cause listed on line a. ATHETZOSCLEROSI4
<br />UNDERLYING CAUSE (disease •Due To (Or As A Consequerice Of):
<br />or injury that initiated the d.
<br />• events resulting in death)
<br />LISTED LAST
<br />Part .17. Other Significant Conditions Contributing To Death Sut Not Resulting In The Underlying Cause Gillen In Part I.
<br />29a. Autopsy
<br />NO
<br />:;:-...,...,
<br />2,9.0.:•..,C0P,i.O.i.- Ci4itactect';:!........: "..:::.;::'•:';''''!.;1'1
<br />. .
<br />Ne$:::'"'•'..-
<br />32.1,,Larin...Of Raaitl ••••••,:,..:.-,,.:......,,,,•;.- .
<br />::.:,.....•:::NATI)RAL
<br />. . .
<br />. .
<br />29b. Autopsy Fintliags
<br />To Complete The Caese.Of.Deith:
<br />. • .. .
<br />. .
<br />30. Did Tobacco Use Contribute To Death,
<br />31. If Female:
<br />NOT PREGNANT WITHIN THE PAST YEAR •
<br />33a. Date Of Injury (Month, Day, year)
<br />33b, Time Of Injury : . •
<br />. .
<br />33c.Injury At Work
<br />33d. Row Injury Occurred
<br />34a. Date Pronounced Dead (Month, Day, Year)
<br />06/26/2016
<br />35a. Pronouncing and Certifying Physician'
<br />/e/FREDERICK SHORT - DO
<br />VS231A - Rev. 07/01/2009
<br />Death 7/6/2016 V240184100 01 20160401 1888 8c tt Processing
<br />33f. Location (Street And Number Or Rural Route, Qty Or ToWil, State, Arid Zp Code)
<br />• 34b. Time Pronounced Dead
<br />6:35 PM
<br />35b. License No.
<br />. 520840
<br />34c. Actual Or Presumed Time Of Death
<br />6:35 PM
<br />35c. Date Certified
<br />06/27/2016
<br />Noire of Person Pi.Oriounclii4:Deatti
<br />•
<br />35d. Address And ZiO'Code:g.*Periqn.CoMPletitirj caute of:Death.
<br />13813 W 76TH CIR, KANSAS,
<br />346. Licease
<br />
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