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� � <br /> � � � � <br /> � � � � <br /> � m � � <br /> � I � <br /> � �' � _ .. � <br /> � � � � <br /> , � � o � � <br /> ?� C� � n � <br /> � � � � rn � � <br /> � rn --c ..� <br /> � � , ��, t-+ Q � � s� <br /> � � � � � � z � � <br /> '� r°r� ��i� -� Ti � o � <br /> � (�n � m r ;v -. <br /> O \ � � � � cn � rcr' � � <br /> � 10510:� � � � � <br /> o � <br /> . �, C��- D ~' <br /> . ,. �, ,.-�.., <br /> � `c' � o <br /> cn • <br /> :��.c _ <br /> WHEN TH/S COPYCAPo�S TF�RAI3ED SEAL OF THE NEBRA3KA F�ALTH AMD HUMAN SERVINCE� �_ <br /> SYSTaEII�IT CERT/FES TF�BELO W TO BE A TRUE COPY OF THE OA'IO�WLL - " <br /> THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM,VITAL 3TA �g � <br /> THE LEOAL DEPOS/TORY FOR VITAL RECORD� � _ �-- <br /> DA ISS!/ANCE �- �� ���� -N ��'�°�- -= . <br /> �'� 101999 9 :�;: ����o� <br /> as��,e+v�;����s� <br /> ������ HEALTH AN g�q � <br /> STA'[E OF NEBRASKA-DEPAR11NbNT OF HEALTH AND HUMA "- :� . <br /> VIfAL STAT[STICS ���- � <br /> CERTIFICATE OF DEATI-F"-�-�-:�����"}*�. : <br /> 1.pECE�ENT-NAME FIRST MIDDLE UST 2 SEX'-��_---- (�pF�A� ��Dey y�� <br /> Earl Eugene McWilliams Male � ' May l, 1999 <br /> 0.pTV AND STATE OF BIRTH /Hnd n USA..name cowrby/ Se.AGE-Uat&NWey UNDEH 1 VEAR UNDER 1 DAY 6.DATE OF BIRTH /Mpnfh,Day.Yeer/ <br /> Unadilla, Nebraska �`'f5� 73 � Mos I DAYS Sc.HOURS' MINS TanUary 11, 1926 <br /> u <br /> 7.SOCiAI SECURTIY NUMBEF Ba.PLqCE OF DEATH <br /> 507-36-2650 HOSPITAL � Inpa�iBM OTHER � Nursing Mome <br /> 3G.FACILITY-Name /HndNrsfihuA'pLyiWSyylanynwnDN/ � EROutpa6ent � Resbence <br /> Tiffany Square Care Center ❑ �oa ❑ ahe,��,ty, <br />!c.GTY.TOWN QR�pCAT1pN OF OEATM Sd.INSIDE CITV LIMITS Be.COUNTV OF DEATH � <br /> C3�'a�'I�3.ant�� NebraBka . ; . � , <br /> :; <br /> . . r.. ��•�. "- ?E�di���:� r. <br /> 9a.RESIDENCE-STATE 9b.COUNTY 9c.GTY.TOWN OR LOCATION ?A.STREET AND 4UMBER /lnc/uO>r�ZrO Code1� �9e.INSIDE CITV LIMITS <br /> Nebraska Hall Grand Island 2118 North Sherman 6880 �es� No❑ <br /> 10.RACE-�e.g.,Wni1e.BIacN.Amencan Indian. 11.ANCESTRV le.q..llalian.Mexican.German,etcl 12.�MARRIED a WIDOWED 13.NAME OF SPOUSE /H wde.give maiden nameJ <br /> eic.l�soearyl t�ri, ISOSeM <br /> ��l�lte American NEVER DNORCED Ruth Brammeier <br /> 4a.uSUAL OCCUPATIpN /Gne kmd d r»nt ddy dvring mpy tID.KINO OF BUSINESS INDUSTRV 15.EDUCATION (Speciy only�gMat pra0a cpmplel9d) <br /> d waki lilB.eron il reNed! ry �11.a or 5•1 � <br /> Electronic's Technician F� E�^����s�«� �o-,z, <br /> 6.FATMER•NAME FIHST MIpp�E LAST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME � <br /> Charles Christopher McWilliams Leona PJeber � <br /> B.wnS DECEASED EVER IN U.S.ARMED FOpCES? 19a INFORMANT-NAME <br /> Ves no or unk.) (M yes.g ve w aM tla4s d f�rvicq � <br /> �es P�W I 1j8r1946-10/�ll/1948 Ruth McWilliams <br /> 9� INFURMANT MAILING ADDRESS IS7REET OR R.F.D.NO..CITY Op TOWN.STATE.ZIPI � <br /> 2118 North Sherman Grand Island, Nebraska 68803 <br />!0.EMBAL NATUFEBL SE �. �Z/� 21a.METHODpFq$POS�TION 21D.DATE 21C.CEMETERYOFCREMATORV-NAME � <br /> � � -�it �8���.� �Removal May 5, 1999 �Westlawn Memorial Park ^ <br /> 2a FUNERAL HOME-NAME 27tl.CEMETERV OR CAEMATORV LOCATION CITV OR TOWN STATE <br />�pfel-Butler-Geddes ❑�'°�°"°^ ❑°onation Grand Island, NebrasJta <br /> 2p.FUNERAL HOME ADDRESS ISTREET Ofi R.F.D.NO..CITV OR TOWN.STATE.ZIPI --- /" <br />.123 West Second Street Grand Island, Nebraska 68801 <br /> 3. IMMEDIA7E CAU (ENTE ONLY E CAUSE PER UNE FOA ia1.IDI.AND�cp � IMerval petwqen onset anG oeatn <br /> PART t I <br /> � lal • ��J � �l. �� , ��� �_ S^ � � ��r� ) <br /> DUE TO,0 A CONSEOUE OF . ' I Inlerryl�el�p9en 1 aM tlealn <br /> _ i ��oi �-� � �_Q.t�L�-�c� ; �,,� <br />� WE O.OR AE A ENCE OF: - � Mtxval pslwnn p� Oeatn �- <br /> � <br /> Icl I <br /> i <br /> OTHER SIGNIFICANT CONDITIONS-CandNions contribudrp to Me CeaM but not relatetl PAR�III IF FEMALE.WAS THERE A 2a AUTOPSV 25.WAS CASE iiEFERRED TO MEDICAL <br /> PApT PREGNANCV IN THE PAST�MGNTHS7 EXAMINER OR CORONER� <br /> fl V �� <br /> �Aqes 70-Sd� Ves No Ves No Yes No n <br /> w� 28b.DATE OF IWUFV /Mb..pay.Yr.) 26c.HpUq pF INJURV 26E.DESCRIBE HOW INJURV OCCURRED OU <br /> � O � <br />� AccMenl � Untl�Mrmine0 M � <br />� Swc�Oe � PenOmg 28a,INJUHV AT WORK 2&.p�,�CE p��NJUiiV•Athpn�.larm.sveet�ac�ay 26g.LOCATION STFEET OR R.F.D.NO. C�7v OR TOWN STATE O <br /> ❑ ❑ o�ce buildir�q ak. /SpscMl �p <br />] HomiCiOe InvesM1gatMn VBq (.b � � . <br /> 27a.OATE OP DEATH /MO.Day.YrJ 28a.DATE SIGNEO /Mo.Day.Vrl 28b TIME OF DEATH • ���� <br />= May 1, 1999 <> M <br /> �-� M <br />✓s'y, 27b.DATE SIGNED /MO..Day.Yr� 27c TIME OF DEATH '�� 28c.PRONOUNCED OEAD /MO_Dey,Yc/ 28A.PRONOUNCED DEAD /HOUrI <br />�� May 4, 1999 7;35 AM M ���� <br /> 2�a ro me ear a k g � M <br /> mY nowbOga.aaetn oecurrsE n ths 6ma,Esro qaes a due ro Ma ��u 2Be.On Me Dasis d examinaam ana�a� tion,im m �wn Caam occunetl at <br /> causelsl statetl. � .� ti o a �^�s�'9a Y�p <br /> �hB timB,Ca�B 8nd p12C8 antl tlUC W tlM C8u5B�3)3�eIBA. <br /> IS naNrs anE Tilb► �S naNre arM Ti11e <br />.OID T BACCO USE CONTRIBUTE TO THE DEATH? .a AS OAN pR TISSUE DONATION BEEN CONSIDERED? 30.0 WAS CONSENT GRANTED7 <br /> �ES � NO � UNKNOWN � VES �!O � VES � NO <br />. E AND ADDRESS OF CEFTIFIER�PHVSICUN,CORONER'S PNYSIC4IN OR CWNTV ATTORNEVI /Type a Prinp <br /> r. William J. Landis 2 West Fa'dle A e G n <br /> a.REGISTiiAR ��+ 32p.DATE PILED B■.Ei„RAF /b1o..Day.-c1 ... <br />