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WHEN THIS COPYCARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTE1 4 !! CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECOft DNfIW V"
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SE077ON,- *MCH I
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE N• . " "�.
<br />MAY 11998
<br />ANLYS COOPER =a
<br />ASSISTAI& STATE REGISTRAR -_
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVCES SYSTEM = "
<br />200111983
<br />STATE OF NEBRASKA — DEPARTMENT OF HEALTH 957,-04773
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />I. DECEDENT • NAME FIRST SADDLE LAST
<br />t SEX
<br />7 DAIS OF DEATH Alk w DA. r.Aq
<br />Anthony Joseph LaRue aka LoBue
<br />Male
<br />April 21, 1995
<br />4CfPYANDVAT1OFftRTW r1IA4w USA r - nNr,Pp
<br />5. AGE We BN7br
<br />UNDER l YEAR
<br />(DER I DAY
<br />• DATE OF Bran ,AI o OIN YAP!
<br />>v W)S I DAYS
<br />SC Nark MANS
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<br />New York City, New York
<br />rynl 85
<br />A t 10, 1909
<br />I SOCIAL SECURITY MAMA
<br />Y PIACE U RUTH
<br />❑ `"F`" �� ❑`
<br />350 -03- 69831A`
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<br />ft FA=V -NN,Nr p�A..NAr.NI Y+r w�rw riO nrwe+•1
<br />St. Francis Medical Center
<br />❑ DOA ❑ °""'SO' A —
<br />« CnY. TOWN OR LOCATION p DEAtH
<br />Bts NS" CITY LIMITS
<br />M COl1NTY OF DEATH - —�
<br />and
<br />Yw ® N. ❑
<br />Hall Count
<br />RESIDENCE•S1A/E
<br />R COUNTY
<br />CITY TOWNORLOCATgy/
<br />9a SIN E1 NCO MARL IKAe;.1 Grd, w Y S
<br />- Nebraska
<br />Hall
<br />19C
<br />Grand Island
<br />1104 W. 7th St. 68801 Y« :a. ❑
<br />IFEW. MB. WIMF ■r7 ArwsFA P,OrR
<br />11 ANCEBTRr a0. a1IiAL Mwcrl Ornr,l rtl
<br />17 (1 MAIMED a w100WE0
<br />fT NAME OF YOU6t rl.dr MwMr.IrMMI
<br />.slM.arn White
<br />mo.tsrrl American o�
<br />NEVER o�ED
<br />Jeannette Loughmiller
<br />tY TISIIAI OCCUPAiID11 10+. MfWrw dFNRr AFwpnw TAn KND OF 90M 38 MOWSIRY IS EDUCATION _S ar+r ,ft ca.rrAr4
<br />FATION
<br />MNA&OCC
<br />.A r Q,a c...0. „.s,•,
<br />Retired U.S. 01b Gotiernment r�u0 E 12t�1 Grade
<br />MOTHER FIRST MIDDLE MAIDEN RIN
<br />It FATHER •. NAME FIST MIDDLE I”, BUAE
<br />John NM LoBue (Dec.) Maria Assunta Cozzo (Dec.)
<br />19 WAS DECEASED EVER N US N.WU FORMSI
<br />IfIF XrfON.AANI NAME
<br />IraAArv►1 N1MP».r,rddYFd MYNts.rl
<br />Yes WWII- Korean 1943 -1964
<br />Jeannette LaRue
<br />IQ 00OFMWT MALOGADOMSS ISIRf ETO1RRFD NO CITYORTOWN STATE DPI
<br />1104 W. 7th St., Grand Island, Nebraska 68801
<br />'b AIBM .EIONAIURE a UCENiF
<br />)T. M[IHpp(r DgPrrinir,,N
<br />,IO DATT ?Tf
<br />Cl MNEIWY OACRtMATUN. NAME
<br />®8,,, ❑,N—,
<br />April 24, 1995
<br />Westlawn Memorial Park
<br />?Ja HOME •NAME
<br />)Iq Cl ME1tRVORCIOVAIURVLOCATF,)N UP, ',m fam STATE
<br />FINEPIAL
<br />Kleine Funeral Home
<br />❑ °i"'° 0 °" °
<br />Grand Island, Nebraska
<br />}EB FLOIFFIAL HOW ADDRESS ISIREET ORRFO NO CITY OR TO/rrt STATE. Dry .
<br />3213 W. North Front St., Grand Island, Nebraska 68803
<br />ANIEWTE CAUSE FA ONL r ONE CAUSE HEN LINE NO iN AND wrY OMRIrfAR ptNFlyd rANFN
<br />IA11T �
<br />a E[ G '( 4�l firms .'t"4 Gi l/` 141y
<br />DUE TQ OR AS A CVMQkAft= Of IT wrr aFIIR.w rEr rd rNw
<br />_
<br />DUE TO OR ASA CONSEOUE AIM OF w.. �W"Al,e d!
<br />Ifl
<br />OT HE H SIGNIFICANT CONOITIUh9.`0 nN --OWV p/,.tsar, W"a nN...
<br />PAHiASNtMALE WAS TNEHEA AUTOPSY-
<br />WAS f.ASN HNrUrEUtO MfoTCAI
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<br />20 DATE OF wAPRV ASP Oft "I
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<br />DATE OF. DEATH iW DIN, VN!
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<br />7FA DATE SGNED iW D?Ar trl
<br />rb TAE OF DEATH
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<br />DATE SIGNED 440 ON'VIP � lAE OF DEATH
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<br />DID TOBACCO
<br />USE CONTRIBU OU1M
<br />OR IISSUE DONATION BEEN CONSIDEIED'N
<br />OWKCONSENI C/IMIIED'
<br />❑ YES ❑ NO ® .MINDWN
<br />R] YfS � NO
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<br />„ NAME AND ADDRESS OF CERTIFIER "VY A S PHr5K7AN OA CORNTY ATTOR.rt r, r rT, PP+
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<br />m REGISTRAR tis DATE FEED SY V4i^IHAR AO 0. nl
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