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202301498 <br />Peva I I /g7 STATE O7 NEBRASKA- DEPARTMENT OI HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT <br />VITAL STATISTICS <br />CERTIFICATE OF DEATH <br />1 DECEDENT • NAME <br />Waldo <br />FIRS, <br />Etnier <br />MIDDLE <br />Ruhe <br />LAST <br />2 SEX <br />Male <br />4 CRY AND STATE OF BIRTH /N oath USA. nano molly) <br />Abbott, Nebraska <br />S.. AGE • Last Skad.y <br />rite 183 <br />UNDER YEAR <br />92 MOS.1 DAYS <br />UNDER 1 DAY <br />EE. HOURSMINS <br />3 DATE OF DEATH Noah DM Hod <br />October 1, 1999 <br />6. DATE OF EIRTH Okra b.M Peel <br />June 28, 1916 <br />7 SOCIAL MURRY NUMBER <br />508-01-1458 <br />9b F ACIU?Y . Nam. /N rot wrsN tkn 9M oM..r sod number! <br />St. Francis Medical Center <br />S.. PLACE OF DEATH <br />HOSPITAL: <br />Sc. CRY TOWN OR LOCATION OF DEATH <br />Grand Island <br />ed. ONSIDE CITY LIMITS <br />Yea la No D <br />kaMlenl OTHER. 0 Nursing Homs <br />DERO D <br />DOA Cater t8bodl r <br />ea COUNTY OF DEATH • <br />Hall <br />Oa. RESIDENCE• STATE • <br />Nebraska <br />Nb COUNTY <br />Hall <br />Se. CITY. TOWN OR LOCATION <br />Grand Island <br />gd. STREET AND NUMBER 19+001g29,&MO <br />2508 Commerce 68801 <br />M INF.OS cot,. <br />Y�®wD <br />10 RACE • N•g.. Whites Slack. American Millen. <br />e4c I ISNecoV1 <br />White <br />11. ANCESTRY l q.. M.Nws Mexican. German. Oct <br />re.ecM American <br />12. ® MARRIED <br />DNEVER <br />MARRIED <br />0 w1DDwE0 <br />DON <br />Ws USUAL OCCUPATION Nino Model work doom &Ning most <br />Ol oork*p w. elan NntrMI <br />Self -Employed Contractor <br />142 KIND OP GUINNESS INDUSTRY <br />Construction <br />18. FATHER . NAME FIRST MEDDLE LAST 17. MOTHER FIRST <br />u ' Waldo E. Ruhe N1 Ada <br />t; 15. WA►DECEA261veR 1F U.S. MIMED FORCES? (21 INFORIU .NAME <br />rvMYes .I (WWII 2/194 /3/45 Dorothy Ruhe - Wife <br />Igo INFORMANT MAILING ADDRESS (STREET OR R.F.D. NO.. OR TOWN. STATE. BPI <br />2508 Commerce, Grand Island, Nebraska 68801 <br />I. <br />WZ E <br />0 <br />U•NS,D Livingston -Sondermann F.H. <br />W �, 220. FUNERAL HOME ADDRESS (STREET OR R.F.D. NO.. CITY OR TOWN. STATE.21P1 <br />In .0 <br />U.CL <br />601 <br />IN601 N. Webb Road, Grand Island, Nebraska 68803-4050 <br />ME0ATE CAUSE TER OtLLV CAUSE LNIE FOR 1.1. IN. AND ION I beerval . .+. M M.. <br />1 <br />a -�' (aPART CV` auk BIS ext <br />aft- �-!.' :l. - <br />DUE TO. OR ASA CONSE OF: ( 1 r.erval b.aeaan ewaw .1.1.r <br />LL LE LU A V1-ec► giN0a. % iA? I e .�' re Pros C� t °t 1 1 I99? <br />MER • SIGNATURES LICENSE 140. <br />R, a,BL 1/43 <br />21a. METHOD OF DISPOSITION <br />® Budd D Removal <br />DCseinsgenDon <br />22e. FUNERAL HOME • NAME <br />21b DATE <br />13 NAME OF IIMM NNaX' moo? <br />°ICED Dorothy Torskey <br />19. EDUCATION ISp••Monly NM1••19t deOPIVINtel <br />E a g425 Caddo 11 a n. <br />s• i <br />th ra ee <br />MIDDLE MAIDEN SURNAME <br />NMN McKown <br />Oct. 4, 1999 <br />21c. CEMETERY OR CREMATORY . NAME <br />Westlawn Memorial <br />21d. CEMETERY 014 CREMATORY LOCATION CRY OR TOME. <br />Grand Island, Nebraska <br />Park <br />51A1E <br />lel <br />OTHER SIGNIFICANT CONDITIONS • Conditions con*NAMng to lite dean but nal Weed PART MIF FEMALE WAS THERE A 24 AUTOPSY 25 WAS CASE 210826E4 TO MSDIC.AA <br />PART PREGNANCY IN THE PASTI �a MONTHS? Jr-.XAMINEN OR CORONER' <br />(Ago 10.541 YM 1 1 No Yam' ElNo vv. ❑ <br />4e. 25b DATE OF INJURY /1.42. Day. YrJ Me. HOUR OF INJURY 25d. DESCRIBE HOW INJURY OCCURRED <br />❑ /incision' 0 Undetermined <br />❑ Suicide 0 Pending <br />❑ HomicMe Investigation <br />M <br />20e. INJURY AT WORK <br />Yes NoD <br />20. P OF tic. 44V lam anal Way <br />26g. LOCATION . STREET OR R.F.D. NO. CRY OR TOWN STAT? <br />111 <br />■ 127d. To Me bee elIlly kno0Ndge. <br />Med. <br />27e DATE OF DEATH 1AIa. Day. WI <br />1/ <br />27b DATE WISED (lb. Cay. WI <br />"/4//91 <br />27c. TIME OF DEATH <br />29 DID TOBACCO 118E CONt1:BUTE TO THE <br />- D YES 0 No <br />k 1.') <br />=lend 1111110 <br />6.1.. dr. 014 place and due b M <br />266 DATE SIGNED IAI1. Day. Yr I <br />292 TIME OP DEATH <br />29c. PRONOUNCED DEAD IMo.0 . W/ <br />201 On 9M bags el a.rlwl2Nal 010.12 <br />We (rte. deb and 61629 PIM <br />2E41MNg NIM( TOM ► <br />30.a HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? <br />0 2E8 (I <br />SI • fiJA*.ANNDD A101ESS OF CERTMIWI WHYS/CAN. CON( {Efs�PHYSI01244,ON °OUNTY AlORNEY( K] p �y ��/ }- <br />aEo�l{TRwSi -ei / , t i- ern /�o IE% / LQdga. .�1�� L/ oe ',PAW tab. DAT Pat. oJSY R ?RtIe uea� <br />290. MIONOUeCE0 DEAD IMvr <br />aydp1Mee <br />1114 <br />M <br />FOR VITAL STATISTICS USE ONLY <br />Place A B C • <br />O E Pert U TMV <br />NSC Census Tract No. <br />Work <br />UC <br />Reject - •• <br />'MINI ANI. ase ilk ee weyetee e.ve, <br />here`,„ �,, ,,. x?., n _ <br />Si 4e of NebrL /1 <br />CX/Oir4 en- Yp11.LJe A0.44T.w! F. cl .: <br />Sigma 1 <br />