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<br /> � WHEN 7HIS COPY CARFtAES TF�RA/SED 3EAL OF THE NEBRASKA NEALTH AND HUMAl�L���F�
<br /> S1^STEl1�IT CERT�S TFAE BELOW TO BE A TRUE COPY OF THE OR/GINAL RECOR�€'�fN���__
<br /> THE NEBRASKA HEALTH AND HUMAN SERV/CES SYSTEM,VITAL STATIST/CS�T/�fF; -'
<br /> THE LEOAL DEPOS/TORY FOR VITAL RECORDS - = - ��= =
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<br /> DATE OF/33UANCE _-'��/Jq�, Lt+ -
<br /> . - �T �_ _� s -
<br /> M�AY 2 51999 ��.�,�::==�
<br /> L/NCOLN,NEBRASKA ASS/STAIY��iq�E I?�0/3TRAR�.=_�
<br /> HEALTH AND HUMAN'�ERV��j�'�- __
<br /> STATE OF NEBRASKA-DEPARIMENI'OF HEAi.TH AND H[]kUN SERVICE��iC$�_��^-_� '�
<br /> V1TAL STAIISI'!CS -- _ _.������
<br /> -_� -- - - .
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<br /> CERTIFICATE OF DEATH '�==ti-' °�
<br /> ' 1.DECEDENT-NAME FIRST MIODLE IAST 2.SE% 3.DATE OF DEATH /MOnM.Day Vear/
<br /> Earle Howard Karle Male May 15, 1999
<br /> 4.CI7v AND STATE OF BIRTH lHnd n U.SA.,name counby) Sa.AGE-Last Birthday UNDER 1 VEAR UNDER 1 DAV 6.DATE OF BIRTH /MOnM.Day Vear/
<br /> Grand Island, Nebraska 'Yrs' �g �.Mos. DAYS x:�o�AS� M�NS. �Y 24, 1919
<br /> 7.SOCIAL SECURTIV NUMBER 88.PUCE OF DEATH
<br /> 507-14-2413 HOSPITAI: � InpaNgM OTHER � Nursmg Home
<br /> Bb.FAqUTY-Name /M not mshhqinq 9n'e st�eM end number/ . -_�- � ER
<br /> B� 0��� � Re5i0ence
<br /> St. Francis Medical Center ❑ ooA � �,,S�,W,
<br /> 8c.CITV.TOWN OR LOCATION OF DEATH Bd.INSIDE CRY LIMITS Be.COUNTY pF DEATM
<br /> Grand Island �a5 �X No ❑ Hall
<br /> 9a.RESIDENCE-STA7E 9b.COUNTV 9C.CITV.TOWN OR LOCA71pN. 9d.S R ET AND NUMBER I l ingZip Cade/ 9e INSIDE CITV LIMITS
<br /> Nebraska Hall Grand Island 4��5 West d'�� Potash
<br /> 6£tt303 �a5 X❑ No❑
<br /> 70.RACE-(e.g.,While,Black.Amencan Indian. 11.ANCESTRV Ie.g..Ilalian,Mezican.Germen,ptc� 12.�MApRIED ❑WIDpWED 13.NAME OF SPOUSE I/wHe
<br /> e1c.I lSpecly� ISDeci � l .give maiden name/
<br /> ��p,, y NEVER
<br /> ��il�'te American aVORCED Viola Ta e
<br /> 1�a.USUAL OCCUPATION /Give keMd�rk abne obrpiy mos� tab.KIND OF BUSINESS INDUSTRY 15.EDUCATION �Speciy only hgheat gratle completeC)
<br /> d working IAe,e`gn i/rBlirgd�
<br /> Farmer E�^��n'?��ary 10-121 Cdlege It-a or 5•i
<br /> A riculture �
<br /> 16.FATHER-NAME FWST MIDpIE UST 17.MOTHER FIRST MIDDLE MAIDEN SUFlNAME
<br /> John Karle Nodine Quemette
<br /> 1fl'W�S,D«CEASED EVERreg 91�.WAR�a�esaEs.���02-19-1941 �9a.INFpRMANT-NAME
<br /> Yes World War II 09-10-19451 Viola Karle
<br /> 19D.INFORMANT MAILING ApDRESS ISTHEET OR R.F.D.NO..CITV OR TOWN.STATE.ZIP� -
<br /> 4905 West Old Po sh, Grand Island, Nek�raska 68803
<br /> ZO.E 8 ER-SIGhrT d SE 21a.METHOpOFqSPOS1TION 21b.DATE 21c.CEMETERVORCCiEMA70RV�NAME
<br /> �''' �'� U #1071 �B,f1e, ��,��„ 5/19/1999 Grand Island City Cemetex•y
<br /> ApfFUNEFAL NOME-NAME 21d CEMETERY OR CREMATORY LOCATION CRV pR TOWN STATE
<br /> el-Butler-Geddes Funeral
<br /> Home ❑c�e�� ❑oa,�� d I
<br /> 2ffi.FUNERAL HOME ADDRESS �STpEET OR R F.D.NO..Cll V OR TOWN.STATE,ZIP� .
<br /> 1123 West Second Street, Grand Island, Nebraska 68801-5899
<br /> 23. IMMEDIA7E CAUSE �ENTE ONLY ONE CAUSE PER IINE FOR lal.Ib�.AND�cp I Interval beiween onset ana tleatn
<br /> PAfiT • ` '
<br /> � � ; 2.
<br /> �al
<br /> DUE TO,OR AS A CONSEO NCE OF .
<br /> � � Imenai^Detween onset aM deam
<br /> i 'l�W�--�
<br /> i�I -O• � i �`
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<br /> DUE 70.OR AS A CONSEOUEIJCE OF�. , IMerval cetween onset an�,tleatn
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<br /> OTHER SIGNIFICANT CONDITIONS-Condilions coMribuling tp pie OeaM Mn nd reiateC PART III if FEMALE.WAS THERE A 2a.AUTOPSV I 25.WAS CASE REFERRED TO MEDICAL
<br /> PAR7
<br /> II PREGNANCV IN THE PAST 3 MONTHS? E%AMINER OR CORONER?
<br /> (Ages 10-54� Ves No Ves No Yes No
<br /> �a� 26D.DATE OF INJURY /A}p..Day.Yr.J 26c.HOUR OF INJURY 2BE,DESCRIBE HOW INJURV OCCURRED
<br /> � Acadenl � Unde�ermineA
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<br /> � Su�citle � Pentlirg 26e.INJURV AT WORK 26f.PLqCEOF.INJURV- ,farm,street.laclory 26g.LOCATION STREET OR R.F.D.NQ CITV OR TOWN STATE
<br /> ❑ . ❑ ❑ dfice bwldmg,etc /��
<br /> MomiaAe InvesGgation yqs No
<br /> 27a.DATE OF DEATH /MO..Oay.Y 28a.DATE SIGNED (MO.Day Yr/ 28b TIME OP DEA7M
<br /> na ^_ I 3'S"�c' M
<br /> � 27E.OATE SIG ED /MO..Day,Yr J 27t TIME Of DEATH `�'O 28c.PRpNOUNCEO DEAD /Mo.Day,ri./ 28d,PRONOUNCED OEAD /hburl
<br /> ��� " 2 �3a3 ����
<br /> fi M 8�z M
<br /> a 27d.7o tlie d my k ,deatl�oceurr a dme,dab an0 anE due�o ihe ��� 2Ba.pn pb pegi$p�examinatipn antl�p nvesryga�on,in my ppinim death occurretl al
<br /> eause�sl staMA. �, a the time,tlate anE plece anC due ro the cause�s)slatetl.
<br /> �Si naWre and Ti1b �nature and Tme
<br /> 29.DID TOBACCO USE CONTRIBUTE TO DEATM? 30.a HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? 30.b WAS CONSENT GRANTED?
<br /> � YES � NO UNKNOWN � VES L(,�.�IP� � YES NO
<br /> 31.NAME AND ADDRESS OF CEfiTIFIER�PHVSICIAN,CORONER'S PHVSICIAN OR COUNTY ATTORNEVI� lType a Prinry
<br /> Dr. Gordon J. Hrnicek, 729 North Custer, Grand Island, Nebraska 68803
<br /> 32a.REGIS7RAR
<br /> i 32b.DATE FILED BY REGISTRAR /Mp..Day.Yr/
<br /> MAY 2 41999
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