Laserfiche WebLink
STATE .OF NEBRASKA: <br />WHEN MIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA.DEPARTlifett <br />THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORL? ON" FILE WITI4 77.1E5 <br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS ME=LEG4L <br />DATE OF ISSUANCE- <br />03/1'7/2014 <br />• <br />LINCOLN, NEBRASKA <br />STATE OF 101SEIRA91frR/l+•�DEPlGiTM NTOF1i6A4'N <br />01418/41,4N <br />AND <br />FICATE ' •' <br />DECaDF,NTS NAME (PIM MIddta, Lag. <br />KlmbaN Charles Denman <br />4. CITY ANO STATE OR TERRITORY, OR FORBI N COUNTRY OF BIRTH <br />Fort F:Hey, Kansas <br />T.tloerAt: rlluMeER <br />607444490 ; <br />JACILOY•NAME @t nat Institution, give street and number) <br />Saint Francis Medical Center, <br />ee:,crrY OR TGWNOF DEATH -Vedette Zip Code) <br />Grand Island 68803' <br />eb. RaS1D4RCE.STATE- <br />" ▪ . Tlebraska <br />• re- SU FRE I, ANG NUMBER <br />h,4t 7 Let <br />w It'AeesetirSA 1IME Of<.dea7+4tl enow�d <br />, laeparated 0 Widened - Qheveei <br />St. AGE '• Lastedthd <br />(Yrs.) <br />.b9.. <br />'83.PLACE' <br />7•.f <br />n <br />iss..cotorry <br />Hail <br />t4OATHEStsMAidig. (Rare, ' Mieale, <br />Ifonafa. Denman <br />!Rhonda <br />'$.. Hptrl n <br />TM: MEM roG.= <br />1328~ <br />:flab EVER IN tl$, ARMED FORCES? Give dates of seroh:e NYS'. t4a. INPf)RMAi TNIALIS "r <br />(Yes, No, or Onk.) NO Rhonda 'Dart xr • ' ; <br />4S: M TNOD OP DISPOSITION tea. EMBAI,MER•StONATURE <br />01 IRRIai j] Donation <br />- : Dr�- O,rernetIon Emend <br />f L..�n*ova' : -Q !Other (Specify) <br />TraceyDtetz <br />.. ''.. ":27iii ilit <br />:::" <br />:��--�s71 sr� <br />.RI yi 1�.(I:"it" . 7,--::::::117-:„.. <br />tee.DA <br />Mama j4;•>rp1 <br />lid. CEMETERY, c REMAATORY`OR OTHER LOCATION -- <br />Wood River Cemetery <br />41e: FUNERAL, NOME NAME AND MAILING ADDResB (Street, Cltyor4own, State) <br />r'el Funeral Houle, 1123 W. 2nd, Grand Island, Nebraska <br />CITY-iTOWN :. <br />WOodRiver <br />SSE C BEAU., (:eelne*ror lerm hridmenTletk <br />• de,PARtt.Waren citaleet yants•arrow,Alludea.`orl mpH4te listdt Uy deuddithd IWT_ S .eI - <br />rssiiratory anent, orvwddarhr fib/Mallen without slowing tNaeeolepy. DO NOT ABBREVIA . Nater sway ear caues on a Ora. Add adtdbeeal thaw If aapstiry. <br />; <br />IMMEDIATE CAUSE:' <br />IIMNSDIATEFAD= (that '$AflOXiCBra(a $njlrry <br />dense or cpnditlwnrediena <br />teaaatie <br />isinueenallyMtcofdWons,K <br />any, heading No ea owes Wad <br />oa; nee. <br />r*LUNDigt►r NG CAUSE <br />iehmairertnitayent Intone <br />ANdai ants r4suaha In death). <br />If....I.. <br />ti <br />'• r= ; :i •1 <br />DUE TO, OR AS A CONSEQUENCE OF: <br />b►Cardiac Arrest <br />DUE TO, OR ASA CONSEQUENCE OF: <br />c) Hypercarbic Respiratory Failure <br />Dug TO, OR A CONSEQUENCE OT:' <br />d) Methadone Overdose <br />I F <br />1`' <br />fp A' r I F 1 <br />...,H .Lr, uf4 d t }. a v` S 1:;.! <br />to Mat IE MUER SIONiFICANT CON Unna contrlbuting to the death Euinolrestartyln <br />—Type NOiebetee, Chronic Pain Syndrome <br />20. IF FEMALE: <br />—131,4Al PJn@B wlMla pat year - - <br />1 TI'4aaantid trme er Stat <br />8:00„....,04,„„PrirPlintvatitin Oates! death <br />otMOMk,ft!DOr" Aa451$4TOT WaredNM <br />®.nntniat ititinr uAhen hie tAe pith ten' <br />rak. okTE aR aOURY (i6 i W ' <br />s <br />Mare!? la; 2914 h 09: ftM <br />ri Asa. NWAIaRY AT )i Accidental. Oval <br />_ Q YE5' wig <br />to' Mon i'iton 'JN. `. STREIW S Nu . AFT.NO <br />y 4gt7 t Sty Will! /iv rte: <br />