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� O � .�mS., i D � c a � rn <br /> rn N <br /> � n n ? 7C rn "'� � rn � cD <br /> > <br /> j-� "C m N O c.-> �, o � ca c-�fl <br /> � _ � W � � � p�j <br /> �v Cs O " '�' �� � rD- � � � <br /> p r7 � � r a °O �. <br /> � � r,, �,, F..., cn �, ,`,� <br /> w ~ nw <br /> � � r �� � �.I v/ -J � <br /> � �{ � (/) CD r„�, <br /> �, . � d � `� o <br /> � _ <br /> 9�- ,_i�.�9 �- <br /> WHEN iH/S COPY CARR/ES THE RA/SED SEAL OF THE NEBRASKA HEALTH ANO�I�iCE3 � <br /> SYSTEII�IT CERTIF/ES THE BELOW TO BE A TRllE COPY OF THE OR/O/NAL � <br /> THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM,VITAL STATI � <br /> THE LEQAL DEPOSITORYFOR V/TAL RECORDS k�'-� �= _ - - <br /> _; _ �� - <br /> DATE OF 1SSUANCE _� - <br /> JUN 2 5 �,�„��a = <br /> �999 ' � � <br /> a � �. �� � _ <br /> UNCOLN,NEBRASKA HEALTHAND f�Y' _ <br /> •,. s��.-�. „-->Q <br /> STATE OF NEBRASKA-DEPARTMENT OF HEAL'fH AND HUMAN SER� T <br /> VITAL STAT1Si1CS - "J �=�_ „�� � <br /> CERTIFICATE OF DEATH '--y==- <br /> 1.OECEOENT-MJIAAE FIRST MtDDIE UST 2 SEX � 3.DATE OF DEATH /MOnm.DaK Y�l <br /> 1 Jean Oswald Female June 11 1999 <br /> a.CITV AND S7ATE OF&RTH IMnaf h US.A..nemr eamny) Sa.AGE-Last BinhOay UNOER 7 VEAF UNDER�DAV 8.DATE OF BIRTH /Abnrt Day.YNr/ <br /> (Vn.l Sb.MOS. DAVS Sc.HOURS' MINS. <br /> �llerton Nebraska 58 ' Ma 1 1941 <br /> 7.SOCIAL SECURTIV NUMBER Be.PUCE OF OEATH <br /> ■ 506-50-1849 HOSPITAL: � inpatiem OTHER: � NursinqHOme <br /> Bb.FAdLITV-Name . lHnol msNNtiar,give sheel and numbsr/ � ER Outp�tleM � Residence <br /> . <br /> 1604 Vir inia Drive ❑ °OA ❑ a"°`'S°°"", <br /> &.CITY.TOWN OR LOCATION OF DEATM 8tl.INSIDE CITV UMITS 8�.COUNTV OF OEATH <br /> Gra�nd Island � �•: � "� ❑ Hall <br /> 8�. SIDENCE•STATE _9p.COUNTK, . 9t.CITV.TOWN OR LOCATION 9d.STREET ANO NUMBER /lnep�dYp p CoW) 9�.INSIDE ITV LIMITS <br /> Nebraska Hall Grand Island 604 Virginia Dr., 68803 �ea 0 No❑ <br /> 10.RACE��e.g..Whiro.Black.American Indian. 11.ANCESTRV Ie.g..11allM.Mexican.Oerman,sicl 12.�MARRIED ❑WIDOWED 13.NAME OF SPOUSE /ll w�k.giw m�iden nams/ <br /> e�c.IlSaeayl r.�l�e �SDe�NI �riCan NEVER DIVORCED Robert Oswald <br /> YYl l <br /> 1N.USUAL OCCUPATION lG�w kin0ol Mnrk dars�ring matf 1lD.KIND OF BUSINESS INDUSTRY 15.EOUCATION (Spstily only hiqlyp COmpMMA) <br /> dwakmg�AS.evsnrlrslireCl E a7 -�2) C011ps It-�or5•I <br /> Postal Service Clerk Government ���i�rac'�e <br /> 16.fATNER-NAME FIRST MIDDLE U5T 1).MOTHER FIRST MIDDIE MAIDEN$URNAME <br /> (Dec.) Louie I�II Freeland Dec.) Glad s NMI V lank <br /> �B.WAS DECEASEO EVER IN U.S.ARMED FORCES? t9a.INFORMANT•NAME <br /> �ves.no.or unk I t„ya.qve war an0 Oates o�servicesl � <br /> No 1 <br /> t90 WFORMANT MMIMqADOpESS ISTHEET OR R.FD.NO..CITV OR TOWN.STATE.ZIPI <br /> 1604 Vir inia Drive Grand Island Nebraska 68803 <br /> MER-SIGN 7URE 6 UCEN NO. 21 a.METMOD OF DISPOSITION 21b.OATE 21c CEMETEHV OR CREMATOAV�NAME <br /> � �B���e� ❑Remo�a� June 15 1999 estlawn Memorial Park C,emetE <br /> ERAI NOME-NAME 21 d.GEMETERV OA CREMATORV LOCATpN CITV OR TONM STATE <br /> Kleine F�neral Home �°ri"�" �°°"a'�' Grand Island . Nebraska <br /> 22p FUNERAL HOME ADpRESS ISTREET OR R.F.D.NO.CITV OR TOWN.STATE,DP) <br /> F <br /> � <br /> 213 W. North Front St Grand Island Nebraska 68803 <br /> IMMEDIATE CAU�SEr (ENTER ONIV ONE CAUSE PER UNE FOR ial.ID�.AND�c11 � IMerval Wlrysn onsM anC Oeat� <br /> PARIaI ` `�`�[�{J'��� [ 32GlZ•O r-- Yr'��.._ � � -r-�C-J-�> <br /> � DUE TO.OR AS A CONSEOUENCE OF - i IMxval Dptwssn onaet anA aeatn <br /> ��I � � `�"'�G-�- �--�'--�_.. I / �/� . ri <br /> DUE TO.OR AS A CONSEOUENCE Of�. ' I IMerval W�vsen onaet antl Eeam <br /> ...a�. x . � <br /> �cl , <br /> OTHER SiGNIFICANT CONDITIONS�CaWdlons contributing lo t�e OeaM but nol rel,.ted PAi77 111 IF FEMALE.WAS TMERE A AUTOPS� .WAS CASE REFERRED TO MEDICAL <br /> PART PREGNANCV IN THE PAST 3 MONTHS? EXAMINER OR CORONER� <br /> 11 <br /> �AgestO-Sq ves No Vas No Ves No <br /> 26a 26b.DATE OF INJUFV /MO_Day.Yc/ 26c.HOUR OF INJURV ZBtl.DESCRIBE HOW INJURV OCCURRED <br /> � Acc�tlen� � UntlBlermined M <br /> � � Swaoe � Pending 26e.INJUHV AT WORK 28f.PUB E OF�J�RV%At homg,larm,street Ixrory 26g.LOCATION STREET OR R.f.D.NO. CITV pR TOWN STATE <br /> ❑ ❑ olfi buadi Specny� <br /> . � Homicbe InvesUgauon Yas No <br /> � a.OA7E OF DEATH /MO..Day.n.1 28a DA7E SIGNEO IMO..Day.nJ 2BD TIME OF DEATH <br /> s� -� � q9 ��� M <br /> .DATE SIGNEO /MO..Day.n./ TIME OF DEATM 2& PRONOUNCED DEAD lMO..DIy.Yc/ 28d.PRONOUNCED DEAD /HOUrI <br /> ��� �3\�"/�.� T �. \ ; .� /�,.,.L M ��`'� M <br /> 8� ` �r' $ <br /> 7 To iha bsat d my knowlWga.Oeal�oCCUrr H IM tlrtN ta a plaee anA dx to the �� 2Be.On me beaia d sxammauon an0�a invesupatbn,m my oqnqn GsM aeeumE a� <br /> causelsl rateE. � � me�ima.dets and placs and dua a pw uusa��st�ud. <br /> I nawn W TnN natura and Titls <br /> .DID TOBACCO CONTRI UTE TO TME DEATN? MAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? WAS CONSENT GRANTED? � <br /> VES � NO � UNKNOWN � VES �i11� � � VES ��Nb'-"� <br /> 31.NAME AND ADORESS OF CERTIFIER�PHVSICIAN,CORONER'S PMVSICIAN OR CpUNTV ATTpRNEVI /TypW Rintl <br /> David L. Hawe, NID 2 15 N. s Hastings, Nebraska 68901 <br /> 32e.REGISTMR 32b.DATE FILED BV REGISTRAR /MO.,Div.YiJ <br /> JUN 2 2 i�w <br /> ._ - <br /> .Lo7S 3 l 4�r,� ��:v�32�� ����e�7r�✓yS--. S'e e p•�//J <br />