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WHEN THIS COPY CARR ES THE RAISED SEAL OF THE NE <br />SYSTEM,1T CERT1*S THE BELOW TO BE A TRUE COPY!` <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTeSt.1 <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS <br />DATE OF ISSUANCE <br />SEP 2 91998 <br />LINCOLIK NEBRASKA 41 MIAMI <br />>~ AND <br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND -VOW <br />VITAL STATISTIM ;. <br />CERTIFICATE OF D- <br />1. DECEDENT - NAME FIRST MIDDLE ; LAST <br />Julia Ann Snyder <br />1 <br />2. SEK <br />Female <br />3. ATE OF OEATH - 01/0101111• " <br />September'20, 1998 <br /><. CITY AND STATE OF BIRTH Ill not In USA. name country) <br />Beemer, Nebraska <br />5a. AGE - Lest Biihd y <br />91 <br />UNDER 1 YEAR <br />UNDER 1 DAY <br />B. DATE OF BIRTH (Moo G Day. Year( <br />• <br />January 28, 1927 <br />Sb. MOS. i DAYS <br />-. Sc. rauRs� MINS <br />7. SOCIAL SECURTIY NUMBER <br />508-28-3303 <br />8•. PLACE OF DEATH <br />HOSPITAL: <br />1111Inoeaad <br />OTHER: eiwekMH ns <br />0 <br />- •.. <br />1 NMI. FACILITY - Name /e not midterm Me street and number) <br />St. Francis Skilled Care <br />a <br />■ <br />ER Outpatient <br />=a <br />0 <br />a <br />Residence: <br />OMe«(Saecin: RTri 11 P Par A, <br />Bc.-CITY. TOWN OR LOCATION OF DEATH - <br />Grand Island <br />8d.. <br />• <br />NSIDE CITY LIMITS <br />Ya ®"o 0 <br />6e. COUNTY OF DEATH <br />Hall <br />6: RESIDENCE • STATE <br />Nebraska • <br />9b. COUNTY <br />Hall <br />8c. CITY. TOWN OR LOCATION <br />Grand Island <br />9d. STTD€ T AND NUMBER (N eledM2Z4, CM */ <br />1907 Waugh <br />Be. INSIDE CITY LI/ITB <br />i•« al ie 0- <br />(0. PACE - (e.g., Whale, Black American Malian. <br />me11Spi"ty`White <br />11. ANCESTRY lee. Italian: Mexican. German, etc) <br />(SD" "American <br />12 ❑ <br />■ <br />MARRIED <br />NEVER <br />■ <br />WIDOWED . <br />DlvoRcED <br />13. NAME OF SPOUSE 18 wok eiw maiden dame ' <br />Joseph Snyder (dee.)' <br />14e. USUAL OCCUPATION /Gee k(Md work done during most <br />a*walking lift even Marred) <br />Waitress <br />tet. KINO OF BUSINESS INDUSTRY <br />Several businesses <br />15. -EDUCATION (Specify only MOW graft camaiewo <br />Elementary g Secondary 10.121 ` College 414 a 5•J • <br />J 18 FATHER • NAME FIRST MIDDLE LAST <br />C Otto Rabbass <br />47 MOTHER FIRST MbDLE MAIDEN SU NAME <br />Clara Keisling <br />18 WAS DECEASED <br />(Yes. no. or unk) <br />No <br />EVER IN U.S. ARMED FORCES? <br />I la yea give war and dates of services) <br />19a. INFORMANT - NAME <br />Craig Snyder <br />• 19b. INFORMANT MAUNO ADDRESS ISTREET OR R.F.D. NO. CITY OR TOWN. STATE. ZIP1 . - - - - -- <br />3 N. .ancock Avenue, Grand Island, Nebraska 68801 ,. . <br />24 E, :. • 8LIC= -ENO. �.. 89 ` <br />dr Av.., _ /J //�✓ <br />iiip <br />21a. METHOD OFDISPOSMON <br />]Bunt Removat <br />215. DATE -21c. CE1 TEAY0ACREMATORY:.NAME <br />September 22,'98 Westlawn Memorial Pari. <br />s , . (• - •-•a•-- •. ; NAME <br />Livi gston-Sondermann <br />■ Cremator ❑Donato) <br />' 21d. CEMETERY OR CREMATORY LOCATION _ CATY OR.TONM ` . STATE .... <br />Grand Island, Nebraska <br />22b. FUNERAL HOME ADDRESS (STREET OR R.F.D. NR. CITY OR TOWN. STATE, DP) 601 North Webb Road, Grand Island, Nebraska 68803 <br />23. IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER UNE FOR tai. IDA AND (ey Mwrvatembe en OdNI188 deal* <br />PART ( ///'''��� �1 ..4-1" <br />�. rA <br />J(I Eal � ` �1 `+©J 4-.i �0` , IPC SI <br />DUE TO, OR AS A CONSEQUENCE OF: ` . I Me Mld rgem <br />(b) <br />DUE TO. OR AS A CONSEQUENCE OP I <br />lel <br />` Marvel between beam end dose+ <br />t ii <br />OTHER SIGNIFICANT CONDITIONS • Conditions conb)bulrq to Ate death but not raI.Md <br />PART <br />PART le IF FEMALE: WAS <br />PREGNANCY IN THE PAST <br />(Ages 10-541 Yea <br />THERIA <br />3 <br />SN. <br />- _. <br />MONTHS? <br />❑ <br />24 AUTOPSY <br />' ,E, <br />Ya f Nd <br />RN J�`I�F0OICAL. <br />IMA�11 . T.-" . <br />VVe [ I • <br />26a. <br />0 Accident 0 Undetermined <br />261). GATE QF INJURY . (Mo.. Cay. Yc1 <br />26c. HOUR OF INJURY <br />M <br />25d DESCRIBE HOW INJURY OCCURRED <br />0 Suicide 0 Pending <br />0 Hermes Investigation <br />26e. INJURY AT WORK <br />Ya 0 NoID <br />1 echog, farm. street. factory <br />281. PLACE OF, U V(AD <br />MIM s <br />26g. LOCATION STREET OR R.F.D. NO. CITY OR TOWN STATE <br />271: DATE OF DEATH (Mo.. Day. W.) <br />w <br />28t. DATE SIGNE0 (Mo.. Osy. Yr) <br />2$1;•- T1ME OF DEATH <br />M <br />y <br />- <br />27b. DATE SIGNED (Me_ Day. YrJ <br />27c. TIME OF DEATH <br />M <br />Bli <br />28c. PRONOUNCED DEAD Att. Day, w.)280. <br />PgfROUNCEO DEAD -.(Hata'! - <br />M. <br />27d. To Ifle batt a my 000un ane ,date and anddoe to em .. <br />6.270. To <br />,a\A C ,/� ,... <br />Manske and Tide) IP "�v1 tel =V • 1(2 <br />( <br />5 <br />-28e. On the basis at aamnatioN and'« kw , M my dafbocewn0 a <br />-:_theerne,dawendplaceandduoto4MceaMslsa i <br />► (Signature end Tilt): ... . <br />29. 0(0 TOBACCO USE CONTRIBUTE TO THE <br />Ht 0 YES t1L1 NO <br />DEATH? <br />. <br />. <br />UNKNOWN <br />30a HAS ORGAN OR TISSUE OONATION BEEN CDNS)DEWED? <br />dt 0 YES NO . <br />ab WAS CO NBENt 04.44100 -- <br />x 0 YES NO <br />31. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, CORONER'S PHYSICIAN OR COUNTY ATTORNEYI (Type or 80.4) <br />X J. J. Cannella,729 N. Cu ter, Gran Island, Nebraska 68803 <br />320. REGISTRAR - <br />32b. DATE FILED BY REGISTRAR(Ma. al KV <br />!ere <br />