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<br /> WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE N
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY �
<br /> OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH U�
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEP4�S.ITORY FOR p
<br /> VITAL RECORDS. -
<br /> �---
<br /> -_ �-T
<br /> DATE OF ISSUANCE -
<br /> �iAY 5'199� ;_ � �.._ _ _
<br /> STANI�� � °Ci�O�,, �T��TOR
<br /> LINCOLN, NEBRASKA BUREA�.���TITp,L ,���ICS
<br /> - ---- = _ -_ .' .
<br /> S7ATE OF NEBRASKA-DEPARTMENT OF NEALTNy
<br /> BUREAU OF VITAL STATISTICS
<br /> CERTIFICATE OF DEATH
<br /> t.DECEDENT-NMIE FIRS'� MIDDLE UST 2.SEX 3.DATE OF DEATH (MonM,p�y,yeyi� -'
<br /> �larence Watson Hessel esser ,-
<br /> 9 Male April 23, �yy3
<br /> �.CITV AND STATE Uf&RTH /Mnof in U.S.t,n�me bunby/ Sa.AGE•LM&MOay 8.DATE OF BIRTM (MOnp1,p�y,;w -
<br /> �Yn,) Sp. MpS.I DAYS 6e.MOURS� MINS. �
<br /> �'alley View, Nebraska 74 ; ; A ril 2?, 1�i18
<br /> 7.SOCIAL SF.LUitlTV NUMBER !t PUCE OF DEATH '
<br /> 507-16-5270 Hosvrr�: �i i�w.u.�� ❑en�o�,ro.n.�c ❑oo�
<br /> .c
<br /> � THER: ❑Nunirp Homs D RasWSncs ❑Oryyr/$pscily)
<br /> BC.FAGLI?Y•Wms /pnpf w�Aifyqn,y'ny�j�t Np numbsiJ 8�.CIN,TpWN Qq LOCATION OF DEATM BE.INSIDE CRV UMITS Be.COUNTV pF OEATN
<br /> St. Francis Memorial ,Health Cen er Grand Island «�"Ypa�'�
<br /> Yes Hall
<br /> 9a RESIDENCE-STATE 90.COUNTY 9c.CITV,TOWN OR IOCATION pd.STREET AND NUMBEti IMC1uQMg 2�p CoWJ 9s.INSIDE CITY UMITS
<br /> Nebraska Hall Grand Island 1013 N. Elm ���"Y"a"°'
<br /> t0.RACE-(�.p,Whib,Bl�q�Am�rkan In01�n. 11.ANCESTRV(a.p.,IWi�n,Mexican,�srmen.Mc.) 12.MARRIED.NEVER MARRIED. 13.NAME OF SPOUSE �d wiN.9ivs nuiOen Y�s
<br /> Mt.�( /SWail19 WIDOWED,DIVORCED(SpeaMl
<br /> ite American n� Married Leola . Lindblom
<br /> 1la.USUAL OCCUPATION(QNe kiM d wd4 0on�dvn'ny npy� 1tb.KIND OF BUSINESS INDUSTRY
<br /> d Movkinp 4MR�wn An9rW) n.� EkmsMary a Seeontlary(0-121 � Col
<br /> Mechanic �05 Automotive ��� lp , "'°�+-�°'s.,
<br /> � 18.fATHER-NAME fIRST MIDDLE UST t 7.MOTHER-MAIDEN NAME FIRST MIDDLE UST �
<br /> Watson Hesselgesser • Annice Van Pelt
<br /> � 18.WAS DECEASED EVER IN U.S.ARMED FOqCES? 19.INFORMANT-.NAME-MAILING ADDRESS (STREET OR R.F.D.NO.,CITV OR TpW �p)
<br /> (Yea.ra.a Wc. N Yp, iw wai and daNS d asrvices) �ATAT6i
<br /> Yes: oo��l
<br /> 2 -4�1 11-18-45 Leola Hesselgesser-1013 N. Elm-Grand Island, NE.
<br /> 20a BURIAI,Cnrtution,Rlmpval, 2pb.DATE 20c.CEMETERV OR CREMATORY-NAME Z(Itl.LOCATION CITY pq TOWN
<br /> ��� STATE
<br /> Burial April 26, 1993 Grand Island Cemetery Grand Island, Nebraska
<br /> 21.EMBA MER-SICNATURE 6 LICENSE NO. 22.FUNEFAL HOME-NAME AND ADDRESS (STREET OR R.F.D.NO.,CITY pq TOWN,STATE,ZIP�
<br /> ��l�l !�(/� '�v��v3� Apfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.68801
<br /> 23P�T IMMEDIATE CA� (ENTER ONLV ONE CAUS ER LINE FOR(a�,(b�,ANO�c�� 1 I rval Csnvesn omtl a CeaM
<br /> t . , �_M
<br /> ' � I l�,i�
<br /> ' DUE T OR AS A E NC OF: I I rval Detween onest np
<br /> V �'`' '� �L � D� � i I/�-�.y�
<br /> DUE T0.OR AS A CONSEOUENCE OF: ' " '�
<br /> I Inbrval belween onaet uW deeth
<br /> I
<br /> I
<br /> OTNE�IFICANT CON ONS•CorWNpns conlriDudnp to deat�but not related PART III IF FEMALE,WAS THERE A 2�.AUTOPSV 25.WAS CASE REFERqED TO MEDICAL '
<br /> PART � ` L ♦ PFEGNANCV IN THE PAST 3 MONTHS? /Spetity Yes or No) E)(qMINER OR CORONER?
<br /> II �
<br /> --> 1/� ves❑ No❑ � l�iy ves a Nol
<br /> 26�ACCIDEM,$UICIDE,NOMI UNDET., .DATE OF INJURY /Mo.,pay,Yr.J 28t.HpUR OF INJURV 28C.OESCRIBE HOW INJURV OCCURRED
<br /> OR PENdNG INVESTIGAT Speti/y/
<br /> 28s.INJURV AT WpRK 281.PUCE OF INJURY-At homa,la�m,�eeL fattory, 25g.LOCATION STREET OR R.F.D.N0. CITV OR TOWN STATE
<br /> � ISGkd)'Y�t a Nol olAte DuiWirq.�x. lSP�fi'I
<br /> 27a.DATE OF DEATH /MO.,Wy,ri.) 28a.DATE SIGN€D /Mo.,Day.n.J 2Bb.TIME OF DEATM
<br /> �.�e APRIL 23, 1993 ����b
<br /> ��Y 27D.DATE SIGNEO (MO.,D�y.Yrl 27c TIME OF DEATN �a 28c.PRONOUNCED DEAD /MO..Wy,Yc/ 28tl,pqpNOUNCED DEAD /Fbu�
<br /> s�� APRIL 27 I993 5:35 a �¢��
<br /> Z7a To tM Nu d my knowieape,oe m oocurrsE at ms time.Osu ana e ana aw ro me 8 28e.On the pasio 01 sxaminetwn anE�or investgatron.�n my ownwn Oeath occurnE at
<br /> uws�a��Ltatl. �.c--� p me�ime,tlate ana place ana Cue ro ths cauaels�autsC.
<br /> re entl Titls► 1J � S�naWre antl 7irye
<br /> 2Ya.DID TO&lCCO USE CONTR18UTE TO THE DEATM? 3pa.NAS ORGAN OF TISSUE DONATION BEEN CONSIDERED? 3pp.WAS CONSENT GRANTED?
<br /> YES ❑NO ❑UNKNOWN ❑YES C VES O NO
<br /> 31 NA E AND ADDFESS i CERTIFIEF�PHYSICAN,CORONER'S PMVSICAN OR COUNTY AT70RNEY) (Type or PrtnfJ
<br /> W. J. dis M. . 2444 Faidley, Grand Island, NE. 68803
<br /> 32a REGISTRAR
<br /> 320 DATE FiLED RE�T�R /Mo.,Osy.Yc/
<br /> �
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