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:b � <br /> m ,� _ � <br /> T rn � <br /> '•-{ Z � tT'ti <br /> � = D o 7nE _ � a� cn <br /> r�n cn U, �;p o --1 � <br /> � � � z -+ � m <br /> � � � -� rn �• <br /> '-i � r*+ � "'� -< o �j � <br /> !P" "c,�, _ i,� o `*► N. <br /> o r .:C ''i z F-+ � <br /> �^ z rn cn <br /> � <br /> � rn "@ r-n- � � � <br /> Q �''� � r a � � <br /> � <br /> � � <br /> 9 � � D �, � <br /> _ _ <br /> c�so3� .�.� Z <br /> � � � ° <br /> NE 1//� of Section 3 , Townshi� 11 North, Ran�e 11 West of the 6th ��J ' <br /> P.M. , Hall County, Nebraska, � <br /> _. <br /> WF�N TFNS COPY CAftRIlE3 TFE RAISED SEAL OF THE NEBRASKA HEALTH�i�l�y/CEg - <br /> SY5TEl1�IT CERT�S TFIE BELOW TO BE A TRUE COPY OF THE ORIO/N/Ik <br /> THE NEBRASKA HEALTH AND HUMAN SERN/CES SYSTEM,VITAL STAT�T,�-���(Q�1;-�jS <br /> THE LEOAL DEPOSITORY FOR VITAL RECORD� _-_: ' ' • <br /> /� � <br /> DATE OF/SSUANCE __ -�_"""0,";"= <br /> FEB 18 1999 = �- �---� ° -� <br /> as�i-�rr srarE�Q�s� <br /> UNCOLN,NEBRASKA HEALTH AND/�IMAl1I��-gYS�Y/ <br /> STATE OF NEHRASKA-DEPARIMENI'OF HEALTH AND HUMAAf gE1{yj(�FIN;�r�qp S�p�RT <br /> ViTAL STA'iZSTICS = �O ���Q� <br /> � O J <br /> CERTIFICATE OF DEATH =:-- - <br /> t DECeDENT-NAME FIRST MiD�I.E � LAST 2.SE% 3.DATE OF DEATH /MOmn.Day.Yeail <br /> Robert . Lehr Flory Male October 3, 1998 <br />' 4.CITY ANO STATE OF BIRTH /Nrqf n U.SA.namo counhy) Sa.AGE-Last BiNMay UNOER 1 VEAR UNDER t DAV 6.DATE OF BIRTH lAbntlr.Oay.Vea/ <br /> St. Edward, Nebraska �`'n� 80 w Mos. onvs s�.HOUas� MINS. Tuly 19� 19 18 <br /> J <br /> 7.SOCIAL SECURTIV NUMBER Ba.PUCE OF DEATH <br /> � HOSPITAL: InpalieM OTHER: Nursing Home <br /> 507-12-2022 --- - ❑ <br /> Bb.FACIIITY-Name /pnaf/nsEluMa4 9�8heet aM number/ � � ER OulpetisM � Residence <br /> . Fremont Area Medical Center ❑ �A ❑ o�»��s�,�� <br /> 8c.CITV.TpWN OR LOCATIpN OF pFATH Bd.INSIDE CITV LIMITS Be.COUNN OF DEATH <br /> Fremont _ - v.� � �, ❑ Dodpe � <br /> 9a RESIDENCE•STATE 90.COUNTV 9c.CITV.TOWN OF LOCATION 9d S7qEET AND NUMBER /lncluOinylp Code� 9e INSIDE CITV LIMITS �I <br /> Nebraska Dodge Fremont 2 14 1 Phelps/68025 Y�� No❑ <br /> 10.RACE-le.q..White.Bleck.Mixb�n kqien. 11.ANCESTRV(e.g..141ian.Ma■kan.German.e1c) � 12.�MARRIED ❑WIDOWED 13.NAME OF SPOUSE /ll wde.give maiden�mel <br /> ������ White �SD"�'� American NEVER DIVORCED Joanne Bultzer <br /> 1�a.USUAL OCCUPATION /Give kinCd rpk Jcne durirgmpW '�Q 1<p_KINO OF BUSINESS INDUSTRY �`1 1 t5.EDUCATION (Speciry ony hgMst graEe canpie�ee� <br /> d M°�"g M1.°N�°n9�d1 �J �i Ebmentary a SeCOnEary 10-121 � Cdle9e��.<a 5•I <br /> AtCorne Law w <br /> � 16.FATHER-NAME FIRST MIDOLE UST 17.MOTHER FIRST MIOOLE MAIDEN SURNAME <br /> � <br /> Robert D. Flor Elva L. Lehr <br /> 18.WAS DECEASED EVEH IN U.S.ARMED FOqCES4 19a.INFORMAM-NAME <br /> (Yes.ra.a unk.) �tl yes.qive war antl 0.;tas d servites) <br /> Yes WWII - S/26/42 to I1/45 Joanne Flor /Wife <br /> 19D.INPOAMANT MAILING ADDRESS ISTREET OH R.FD.NO..CIN OR TOWN.STATE.21P) � <br /> 2141 Phel s• Fremont, NE. 68025 <br /> 20.E LMER• TU 8 N0. 21a.METH000FDISPOSiT10N 21D.UATE 21C.CEMETERYORCREMA70RV-NAME <br /> 1 I 37 XQ e�,�� ��mo�a� 10/7/ I 998 Evergreen Cemetery <br /> 2a.FUNE L E E 21d.CEMETERY OR CREMATORY�OCATION CITY OR TpWN STATE <br /> Latt in an-(:hambers Funeral Ham ❑G�"°^ �Do^alan St. Edward Nebraska <br /> 22D.FUNEHAL HOME ADDRESS ISTFEET OR R.F.D.NO..CITV OR TpWN.STATE,ZIP� <br /> 751 North Lincoln; Fremont NE. 68025 <br /> 23. IMMEDIATE CAUSE �ENTER ONLY ONE CAUSE PE LIN F R IaL IDI.AND�cp � I In�erval belween onset antl ffeam <br /> PART � � ^ � �u �� �� <br /> 6�� � � I <br /> ' lal ��/�1 � � � <br /> I <br /> � DUE T0.OR AS A CONSEOUENCE OF: � imervai between onse�ana deam <br /> I <br /> Ib1 � <br /> i <br /> DUE TO.7F AS A C(NJSEOUFNCE OF� � Irnervai De�wcen onsei aM tleatn <br /> I <br /> (�� � <br /> I <br /> OTHER NIFICANT CONqTIONS-CpMiliona tontriWArp b dealh bul nd rNeleC PART III IF FEMALE.WAS THERE A 2d.AUTOPSV 25.WAS CASE REFERRED TO MEDICAL <br /> PART PREGNANCY IN THE PAST 3 MONTNS?� <br /> EXAMINEF OF CORONER <br /> II �/� /� <br /> r �Z( IAges 70-54� Ves No Ves No Ves No <br /> �a. Z6b.DATE OF I URV /Ab..Day.Yr Zfic.HOUR OF INJURY 26d.DESCFIBE HOW INJURV OCCURRED <br /> � Accitlent � Undelermine0 M <br /> � Swcide � PenAirg Z6e.INJURV AT WOFK 26f.Pt CE OF.INJURV-qt Iqrt�e,la�m.Sireet.IacWry 26g.LOCATiON STREET OR R.f.D.NO. GTV OR TOwN S7niE <br /> 1 ❑ ❑ oM ce budAing.ek /S/eci/YI <br /> � HomiciAe Investgalbn Yet No <br /> 27a.DATE OF DEATH /Mo..Day Yc) 28a.DATE SIGNED /MO..Day YiJ 28b TIME OF DEATH <br /> ra r <br /> 52 a � M <br /> g� 2)b.DATE SIGNED (Ab..Day Yr J 27c.TIME OF DEATH `�ai'` 28c.PqONOUNCED DEAD /MO Day.n./ 28E.PHONOUNCED DEAD /Fburl <br /> �`� 10/6/98 11: 55 M <br /> o�' A ��� <br /> g M <br /> 27d.To IM beat d my knowbtlge,doa rreE at the" Ie and ce an0 tlue to the c> 28e.On the basis d examinatron anA�w nvestigation,in my opinion Ceath occur�eC a� <br /> causels�stated. � �v S the time,tlate and pace and aue w Me cause�s�stated. <br /> IS'^alur°entl T'M°► 5 nature antl Title <br /> 29.DID TOBACCO USE CONTRIBUTE TO THE M7 3p.a MAS ORGA Ofi TISSUE DONATION B N CONSIDERED? 30.b WAS CONSENT CaRANTED'+ <br /> � VES � NO. �UNKNOWN � YES NO � YES NO <br /> �--�� <br /> 31.NAME I WO ADORESS OF CERTIFIER(PHVSICIAN,CORONER'S PHYSICIAN OR COUNTY ATTORNEY� /Type y �M� � <br /> Martin F. ars M.D. - 710 Re ds Rd.• Fr nt NE. 2 <br /> 32�.REGISTqAq � 32b.DATE FIIED BV REGISTRAR /Ma.Day.Yi./ <br /> I../:.� -- AAT � � �nnn <br />