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STATE OF NEBRASKA <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAR <br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY op T <br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN St <br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. " .,e1 <br />'20160619g <br />W1�F HE.Aitf, AIV }a <br />AL RE R413 <br />DATE OF ISSUANCE <br />APR 15 2008 <br />LINCOLN, NEBRASKA <br />202109963 <br />STA1EOFNEBRASKA- DEFARYSEN?OFHEALTHANDIe*IAN$ VICES <br />VITAL STATISM <br />CERTIFICATE OF DEATH <br />0{6952 <br />: f: it ` '' -.-.-2 <br />Linda' Mae Baasch <br />E On <br />Female . <br />UNDO 5 MY <br />a DA OP DMTH MOO DA: N,8 <br />June 10, 2003 <br />S DAM or mew Awl 1►' Nil <br />4 CSTY AND NATE OP MTH IVSI*9 i USA. ram MaaaMY1 <br />Sa—.Thatew <br />UNDER T YEAR <br />Grand Island, NebraskaI. <br />64. <br />50 4406 1 DAYS <br />x HOURS MINIS <br />October 10, 1935 . <br />i. SOCNLSmarr NUMSER <br />506-40-1331 • <br />Ie. fLACEOiDEATH <br />nOSPN►�L <br />• <br />".�." oTLI�I <br />N,apH..1, <br />r FAC,JTY-Nn.. /nol.n.LAaK•WALaMMN..Ae,.1S <br />• <br />EROIIpeM ® 411011111023180 <br />D0* 0 °"""�""` <br />South Blaine Street• <br />,< CRY TO:MI DRLOCATgNO0 058205 <br />neon <br />Grand Island <br />84 <br />I <br />NAME <br />Y« <br />E3 Na111Hall <br />M COIMRYOfDEATH <br />• <br />Oa RESIDENCE• STATE <br />Nebraska <br />ID COUNTY <br />Hall <br />Se CITY. T <br />Grand <br />OR LOCATION <br />Island <br />00. STREET MID KHMER aTexdlglb 801 <br />3180 South Blaine street <br />M SMbEC11YLM*8 <br />•"liaiN° <br />■ <br />10 RACE• 1044. NINA MC.. Amman Paw. <br />«GI ISR White <br />11. ANCESTR0 IS ,len111014.01198RIS1 <br />" Danish <br />W. <br />■ <br />MARRIED 0 WIDOWED <br />„' D E] DwgaD <br />/S NAME OE SHOWS HOS pwassawasaw, <br />Bill Baasch • <br />14 USUAL OCCUPATION /Gm. Ardalwkablraang.■PYNAE KP000 BIINIE55 INDUSTRY/, <br />.I.anY.,A4..aRI <br />Bookkeeper •1 Bill Baasch <br />Welding <br />EDUCATION (lto.NyaNy04111011111188132212/0411 <br />EIMMI115T 111.525 Calm I14O 5.5 <br />r <br />/a fATHER • NA.E MST IA100LE LAST <br />Van Trump <br />17 0.401341111 <br />x11001! LINDEN 111/11844421Edmond <br />Alice Redneck* <br />15 WAS DECEASED EVER W U S. ARMED FORCES? <br />1244..0.e. 0441 I 2Yw. p......AaeardNWiwl <br />no I <br />198 <br />+EE 942050 12 •• NAME <br />Bill Baasch <br />104 1149015MNi MAILING /DORM • ISTREET CAR.A0 NO.. CITY OR TOWN STATE. 210 <br />3180 South Blaine Street, Grand Island, Nebraska <br />68801 <br />20 EMBAURER• SONATA! S UCV'NJE NO 211 <br />.7ln� +ria?r <br />WHOOP, OMPOSTIDN <br />r aa.I el... <br />E10 DATE <br />June <br />14, 2003 <br />21c CEMETERY OR CREMATORY NAVE <br />Grand Island Cesetery <br />22a FUNERAL NAME <br />Apfel-Butler-Geddes <br />111 *Mike ll <br />Dwaw <br />210 CEMETERY <br />OR CREMATORY LOCATION <br />CITY 011 TOM WA7E <br />Grand Island, Nebraska <br />E24 •f NOME ADDRESS STREET OR RPD NO CITYOR TOWN. STATE. ail <br />1123 West Second Street, Grand Island, Nebraska <br />68801 <br />25 INAWDATE CAUSE IENTETL ONLY ONE CAUSE PER LINE COR .n <br />1x1 Thc,FsJ.t�, C�..:lurc. <br />MI AND 5.0 <br />...N.I e..w.Aaear.we tram <br />:agvroSE. Q weeel <br />°`' �TO.011 AS A CONSEOUHICI Of <br />i,FroctressEVc su.L rflc at demrnfict, <br />Wawa Wow on.a.ne ream <br />;apwox 5 (feats <br />DUE TO. 04 AS ACONSEOUENCE or <br />NI <br />x.aw x.....na.I.r..e a.r' <br />PARS OTHER OGNMICMIT CONDITIONS - Ce.a.e,. �^I *.r 0..11. * nm,�jl.,N�tl. oA c <br />I D3' D, h IIper4rlen s E'Dn ` Ire, 6 d ease <br />PART a E FELINE <br />PREGNANCY IN <br />(Ara 10-x45 <br />WAS THERE A <br />THE PAST J MONTHS'- <br />yes L 1 No <br />' 1 <br />21 AUTOPSY <br />TES <br />II <br />' <br />N7 in <br />20 WAS CJISE REFERRED TOMEDIC I <br />EXAMINER OR CORONER, <br />Y.. n N. Egl <br />28a <br />. An4wm Rl HH4 <br />2811 DATE OF 8U11RY Mb OW ».1 <br />280 HOUR OF MIJU39 1280 DESCRME <br />I <br />HOW WA an OCCURRED <br />Mneme• <br />M <br />0 &.c.e. RI 05•44819 <br />MANAMA e.pnm. <br />0 vaai <br />08..LAPW AT WOW <br />Y.. 0 No <br />U <br />I Lal gW - AI hl 4— ..4 Homy <br />I NC <br />De e LOCATION STREET OR RP 0 NO C.T V ON TOWN STATE <br />. <br />Vs DATE Of DEATH M12 Dar Y•! <br />June 10, 2003 '19 M <br />250 (TATE SIGNED WO Dew Y.) <br />280 TIME OF DEATH <br />M <br />y <br />g <br />51 <br />214 DATE SNORED At Dar 41 <br />501 <br />21. i,AE OF DEATH 1 p <br />17:45 M 1.1g <br />28e PIIDNOUNCED DEAD AM Oar. Yr I <br />284 PRONOWCED DEAD Nor. <br />M <br />9 j <br />tie TeMWld my .. , .. . Noes .nedue ame <br />ta2-2003 <br />e Onm.bawl <br />,. ~MOON 0..1NIaoDipl. NI RN SD•1w!SPM KCM70M <br />8939955501 .!0m8e and Place ani due 10 M1 MONS 01e110 <br />rMe <br />I • <br />29 DD <br />• - <br />. <br />and <br />• •,• USE CONTRIBUTE • <br />YE5 ® NO <br />• <br />THP <br />UN.... <br />A <br />20a HAS ORGAN OR T <br />NI <br />law p <br />. .. {TION SEEN CONSIDERED' <br />YES ® NG <br />308 WAS CONSENT GRANTED' <br />n YES <br />r <br />NO <br />31 NAME AND ADDRESS OF CERTIFIER IPHYSICAN, CORONER 5 PHYSICIAN OR COUNTY ATTORNEY. Iwe r. Pnn. <br />Steve Susan M.D. 2116 W. Fai ley Ave., Grand Island, NE 688039 <br />2h IN <br />REGISTRAR f 7211 DATE FO 014.134N LY V » <br />(2�Eb I <br />