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2022b4522 <br />STATE OFNaltASK -DEPARTMENT or HEALTH aso ►N MiRVICES FDIANCLANUSUPPOiT 296169 <br />VITA1. STATISTICS <br />CERTIFICAT. OF DEATH <br />1, DECEDENT • NAME . , FAST .. MIDDLE LAST <br />Bonnie Lou Hodgson <br />2., SEX , , <br />Female <br />UNDER 1 DAY <br />i3. DATE OF DEATH !Wash. Day rWl <br />1 <br />September 3, 2000 <br />6 IAm'L DATE OF BIRTH Day nor <br />4 CITY AND STATE 9F BIRTH 111 not In U,$.A. arta awry' <br />Sa AGE • Last BMW <br />UNDER i YEAR <br />. <br />Grand Island, Nebraska <br />(Ytal <br />66 <br />50. MOS. I DAYS <br />Sc. HOURS MINS <br />' <br />_' .:.... <br />November 27, 19133 I <br />7 SOCIAL SECURTIY NUMBER <br />• 503-30-492.0 <br />As PLACE OF DEATH . . <br />719SPITAL [3 Moser* OTHER D NuT..g Home . <br />Q ER OLF0awIN Ra,drd. • <br />OCR [ "ora sr,�'"' <br />FACT Y - ;A not U otarla4 P» steer aaa mo10ar1 <br />1.' University of Nebraska Med. Center <br />. P o1HER SIGNSICANT CONDTONS - CamMoni nowt Wing ID w awl 01A nareraw <br />9 J-�,.�„ <br />BC CITY TOWN OR LOCATION OF DEATH <br />, Omaha <br />8a. INSIDE CITY LIMITS <br />Ya <br />M COUNTY OF DEATH <br />Dora�gla>3 <br />98 RESIDENCE,.; STATE <br />Nebraska <br />9M COUNTY <br />Hall, <br />9c CITY. TOWN OR LOCATION <br />Grand Island <br />Be STREET ANQ NUMBER Mac 4a mzoCmd068801 <br />1401'E„ itecloud Rd. <br />Be INSIDE CITY OMITS ! <br />;'"'"'i,� <br />10. RACE - IRS.. Weft. Waco. Amman tMMan. <br />alc l asyl 1Soa <br />1hite <br />i 1. ANCESTRY leg.. aaMs1. Seale. Garman. ax) <br />1SPacay) - <br />__limed_ an <br />12. <br />p ; <br />pi <br />❑ <br />MARRED, 0 WIDOW& <br />NEVER ONORCED <br />MMHPoED f-1 <br />1 E to orae. NAME OF SPOUSde. gam maldan nanlai <br />Orin Dean Hodgson-' .: <br />14.. alJAL OCCUPATION' (0'.. kind of a ria mai Anrng most <br />. , d abr*,p /W. even 7neradl - <br />. Homemaker <br />lab KIND OF BUSINESS INDUSTRY <br />. . <br />Own Home <br />15 EDUCATION ISbecdy oMy 11.95mM Wade complied) <br />° Iah) CoB.ga�, . Ws.'" <br />le. FATIWN - HAW <br />Roy <br />19. WAS DECEASED EVER IN U.S. ARMED FORMS? <br />no. or ung.)I III yes. 9w. war andcla n a110.i08 ) <br />C► <br />"Dick" <br />LAST <br />Dim®nitt <br />17 MOTHER <br />19a .INFORMANT - NAME <br />1Bb. INFORMANT MAAMNO ADDRESS 1STREET OR R.F O. NO. CITY OR TOWN. STATE DP) <br />• MIDDLE <br />wpm SURNAME <br />Etta Rosetta,; <br />Orin Dean Hodgson <br />'p 1401 East Whitecloud Road, Grand Island, Nebraska 68801 <br />1 <br />I <br />2b. EMBALMER'. SIGNATURE ALICE NO <br />rllyAt 9J <br />dta <br />L <br />METHOD OF <br />Bade <br />DISPOSITION <br />■ <br />Renes H <br />210. DATE 21e CEMETERY OR CREMATORY .NAME <br />Se It. 2000 Grand Island' City Cemetery <br />FUNERAL HOME - NAME <br />Livingstone-Sonderman F. H. <br />Q a.n.ar 0.."'°'Grand <br />Y7, <br />21Q OR CREMATORY L AMR - . CITY OR TOWN , . STATE. . <br />Island Nebraska <br />296 FUNERAL HOME ADDRESS OSTAEET OR: RFD. NO.. CITY OR TOWN. STATE, 21P) I - <br />601 North Webb Road, Grand Island, Nebraska 68803-4050 <br />n <br />a MIEDIATE CAUSE (ENTER ONLY ONE CAUSE PER UNE FOR IN. AND Mg . iaMYalMalan 013ANPM� Yew <br />PART <br />I N`�pQ A ; /1#17w4.440 - <br />'�f}-''- <br />_I <br />OUETTO OR AS A OONSEOUENOE OF ..I • Mrkinunanniso ofleM awl wool <br />pD) MEt 6 A or i .-A,.. 4.3,c-�T!r*t. ,ft 6AAPS, — -`i <br />' DUE TO. OR ABA CONSEQUENCE OF: is - <br />ISI '14°N - S^nPR.S.. 145' L_L. G.. ‘..t. .1/4J(, (—A, .. <br />I Vara beewelleosi and *E <br />..0-4.1. S <br />. P o1HER SIGNSICANT CONDTONS - CamMoni nowt Wing ID w awl 01A nareraw <br />9 J-�,.�„ <br />PART 15 IF FEMALE WAS <br />PREGNANCY VI THE PAST <br />(Aga 10.54) Yam <br />THERE <br />3 <br />• <br />A <br />MONTHS? <br />NII ��j1 <br />2a AIrTOP;1M <br />I -7I <br />Ya :n No 1 I <br />@S.` WAS.CASE � * <br />pwwwER DSR . <br />- Ya': n , Na [' <br />41 <br />W0. DATE OP INJURY pb: Day.. rod <br />2Bc. HOUR OF INJURY , <br />M <br />.f{ <br />265 mESCRSE HOW MAY OCCURRED T'N . / " : <br />0 BMCItl� FwkIHE <br />EGA 174JU Y AT WORK I ., _ <br />� �t, �i <br />IVY lair Wm. stew b ayiy' Zap. LOCATION STsxFT OR SLFD. hitj. . , GDY ORYOWN $TATE <br />IVYISDaellll <br />I Ham iw WAFOSP08 Y}s No i -.. . , <br />--. •f - F -'--.'.r --•2-__. - _�` _—TT <br />�' <br />27A DATE OF DEATH 'Ala. Day. Yr./ <br />Y <br />SBS. DATE BIOMED M(am.. any. Yrl <br />2Bb: -TIM CR:AEATH <br />42Th.OATES20NED <br />(Max Day. Yr.) <br />it _.•. <br />270: TME OF DEATH <br />�` <br />ft.. PRONOUN DEAD Alb. Ory R/ <br />2Ba. PRO40UHCEDDEAD moo. <br />1 • N' <br />RRR <br />270 To lit BM p4 mY lnla'Med� 1 <br />casl ` .a .. -:waro.hM. <br />.era Jlae. ar/ duo Olio <br />2 <br />pia On Be lair elision andW in ay POWS awe aeMelaO a! <br />rFra.aM auobti. ellN Mead. <br />aannirl.and <br />II' <br />2r DID TOBACCO USE • -` A DI4' <br />'YES I I t i.�" Y � •' " UNSNOSWI <br />A o <br />+ <br />k)`"�� <br />• <br />TMSSUE <br />• <br />DONATION a€RE <br />YES � rL, NO <br />sDD WAS WNSMHi GRATED, <br />YES <br />3T. <br />OOUNfY AT10RN <br />ITy5 a PMVj <br />.Grant . Hhtc' i s sMTS, GOC <br />32a iteostiva r a <br />32b. DATE FILED BY REGISTRAR lac: Day. rive <br />SEP 13 2000 <br />a•'�! k6 <br />This certut w;"ddokwelenitto be a true copy of an original record'on file with Vital <br />Statistics. a• 11a1s dtuntribialth Department, Omaha, Nebraska. Certified copies must have <br />a raised seal'in.the area to the left. Reproductions of. this green certificate are not <br />legal copies. <br />SEP 13 2111 <br />Date issued; Registrtar. <br />