|
: � ��..� �___
<br /> _ __
<br /> ;
<br /> -4
<br /> 'F
<br /> � �
<br /> ' ° ° ° � 89�-. 10625�!
<br /> i `� , 1 � � N C� �
<br /> / � ��
<br /> I t+ � � ..�'! •� /'�f y_s' .�<L l . .--f"
<br /> c
<br /> Reg.l c Y,�ee4z '
<br /> STA'!'E OF NEBRASKA—DEPARTM�IVT 06 HEAI.TH
<br /> Bu�eau o!Vital Slalistiea �- -'�
<br /> CERTIFICATE OF DEATH, . �/.�-�
<br /> pEG AlEO-NyMt ����+ "'��� ��» SEt OAit O�0[AiH �ror.�n,o��.r����
<br /> � Reuben Y:ar Holmes � Male � 26 1
<br /> RI1C!�w»,w�aM.�.t�K�r�wOOM, AOE-i�l� uro��� �tu uNOU�o�• D��!Or N�iH�«o�rM. o��, COUNTtl 01 DQATH
<br /> �rt. �tnu�e� b�TMO�\��aa� .w� onq �oun YM 'a��
<br /> � Wh]Lte �. 8 � f� � ,. Ha11
<br /> CnY.iO�M41.O��OCATION O/DlAiN ��tro�cm urm kO3MT�1011 OTMEII NSi1TUT�ON- �t�u.q����nw��.or�s�K�+��a Muwa�
<br /> sru��..ea c�wo
<br /> r.. Grand Tsland ►� Yes �. eter ' '
<br /> STAT}M�A����MOi IM Y 1�..���I CITIIEN 01 wMAI COUNtIIr M�111�IED.7uEVf11 AuRRIlD, SU��IV WG SfOUS!111 wl��,QIV�41PIM q11M�1
<br /> ca,«n.� w�oowEa.orvoecEO��MC,n�
<br /> �. Nebxaska r U.S.A. �� M ie ��
<br /> SOUAL St URI�Y NU�NER USU�I OCCU►ATWN 16�N tMOO��'O�l OOIt�OW�MO�0�1 O� RH�D Of WSxrESS O��NOUST�r
<br /> - �QNllp�III.fY1N U��h�W�
<br /> � „ 508-12-'T326 ,,, Retirea F4r.ner.: �G� ,s r�r.*i °
<br /> � RESIOENC!-S1AlE COUM�I CITr,TOW�O�IOCAT�ON �riro�un wm �TRfET �ND NUMit�
<br /> �t�a��••a o■..o�
<br /> ,h Nebraska ,.� Hal]. ,a Grand Island �.. Yes ��. 218 E. Division
<br /> �AiME��-N4ME hyl ri00t� t�st MOTNE�-MA�DEN NAME ��Ut +�00�� W�
<br /> ,s� (Dec) Dauiel C. Holmes ��� DeC l�i�ni2ie M Morton
<br /> N WAS DKlAS[0 lYE�IN U-S.A�IMlO i0lCESt �N/OfJK�NI-NAME-�ELA110NSMf►-MA4MlG AOO�ESS mnn o�u o .a,cm o.�o.�,ti�,n.�r�
<br /> n�s ���' � �' '" '•'""'`•' Wife Mrs. Anna Holmes 218 E. Division Grand Tsland
<br /> � �-1 -1� 2-�-1 ��.
<br /> ►�RT 1 p�A111 WAS CAUSIO{Y� �lNifR ON1Y ONf CAUSI IfR lINE!O�(o),(A).�NO(t/) � ��nr��w Owf1t�r0 MwM
<br /> � �� wro�•n twf� -.
<br /> � �•� Cardiac arrest moments ;
<br /> , • w » � .
<br /> :�"�e"a:::�.�o c•� Arteriosclerotic heart disease with atrial fil�rillation ears
<br /> �rr�n�n c�vst�e�, � ew ro.u.s•co.a�ovt»u a �'_�
<br /> - sr�t�we t�t vrett. '-` --
<br /> �fIMO C�Y3�lA�l
<br /> <<� H ertenszo � ears �
<br /> MIR M OTMl�116HNlC�NI�ONOIf10N1 CONWTION!COMib�Y1iN610 OlAtN�U1 M0/�EU1t0 /AM�0.11/lA4ll.WAS TNlH A �A�GSr 1/ r�5 rU�tINOtN01 COM• ._'
<br /> TO C�US!6MN IN►ARi N�) Nt6WHCt IN iM���1]MON/NSf t ni O1����� O�Ot�M~�������~�~O C�ut�
<br /> �IS❑ MO Q 11� 1�� HY
<br /> ACC�OEHT.SUK�Dl.NOMVGDl. A ��onrw.0��,q��� {l� MOW IHJUlY OCCU�REO�IMI�rwNn Or�riun ir��n�o�r�n u,rttr u�
<br /> O�VNOETEtev+t0�sna��
<br /> 7U. 2N 1�1 M MI
<br /> iNxi�r�r wo�uc �u►C!W�r+luRr.,�o.�.r��r,1tK��,r.c�on, tOC�nOH �suu�w.�o «o.an o�.o•M,s�.n� -
<br /> 1 f��CtA��f O�MO� OMKt N�6..IK �1HC�n� �
<br /> �. � �
<br /> � CE�TMICATI�PI� rOr�te O�� q�t �Ou�M ��� �p� AMO 4�1 Lr MY/NI\�pW OM �6�o/Oro r01��M MI O[ATM OCCYQlO tl MI hAC1.On DM .
<br /> � I�N: 1O rO�M 0�� �tu �0��Utl�Of�M. �MOY�i P O ri[���t061 NMN
<br /> "�.�.».�.�. p�. �+, �970 »� J�' 26,�975 ��. J� 26�1975 �,� Did ��..2:1.o M,ro�w�Cwae�s��c
<br /> }I� DIC��!!O�Wr -
<br /> CERiMKATIOH-ME01Cw1 EItAIMINE�OI1 COROwER or+■�usn or r� „o��o�a•m rw�oeua»�.+•s nw�wr.ceo ouo 1 ,�
<br /> �7�YM�iIOM M iM W����AIO�iM IMYIf110�fIQM��M��O��MION� YGM}M O�t tl�� MOY� �
<br /> Of�M p[CW�lO Or�MI Ontl iw0 011��O tM CaVSt�11 ST�1�D
<br /> M 77� �"�
<br /> C[RTI/IER-(VIIMI�rN M���«r� UR o�an�a nn� A!SIGNEO��a+TM.o�r,rw� .
<br /> n � ,� !7� �^28-�5 =.
<br /> MARNG A SS-CERiN srnn ��r o bn tt�v t�r �-r�^
<br /> - :� �e�erans �dnunistration Hos ital 2 . o w -¢
<br /> {ubAl.C�EMATION,RliMOVAl CEIMETE��O�CRE�MTO�Y-NAME IOCAiION an O�to.vN Sr•u. �:_—
<br /> �fNC�n� !'•�
<br /> ,... :�► a •� ete r ���. pal-�er I:ebr. , "
<br /> OA �rpeM,D�t,qN� ft1NlAAl MOME-�'/A�ME AND ADO�ESS �St�11/O���O.MO.,plt O�tOww,fh4,b�� ' -
<br /> ,y ,,. :,.. Q :-� _r� des 2r:d F'� ?•iasY:in�or. Grand Isl�nd 21e. 6EE01
<br /> EM� S+G �lt { E !MO. � REGtSTIUR-S�GNAipR� o�n�cenio ar►oe��aeo�srw , .
<br /> �,.. ,��'a��� � ���,����- '���iy��_
<br /> .
<br /> . � - -
<br /> WflEN THIS COFY CARRIES THE RAISED SEAL OF THE I3ESRASKA
<br /> STATE DEPARTMENT OF IiEALTH, IT CERTIFIES TAE ABOVE TO BE
<br /> A TRUE COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE
<br /> - DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br /> IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br /> �O ��� e��'l+t�s./J
<br /> DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR ;
<br /> LINCOLN, NEBRASKA Issuc•�l rlu�ust 18, 1975 �
<br /> � • � �
<br /> �
<br /> �
<br /> � � �
<br /> � J
<br />
|