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�� 108220 RB�i il9� STATE OF NEBRASKA-DEPAR'IMENT OF HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT ' VITAL STA'IISTICS CERTIFICATE OF DEATH 1.OECEDENT•NAME fIRST MIDOLE LAST 2.SE7( J.DATE O�DEATM /Afpllll.Dry�N/1 Thomas Theodore Danaher Male Jul 11, 1999 t CITV ANO STATE OF BIHiH lM no1M USA..n�ms eounhyl Se.AGE•Lul BlrMdey UNDER 1 VEAR UNDER t DAV e.DATE Of BIRTM /AbnM.Day Y�a1 Blltte� Montana �v�s�� MOS. ' DAVS Sc.HOURS' MINS. Ma 11� 1924 7 SOCIAL SECURTIV NUMBER 9s.PIACE OF DEATH 341-30-5523 N09PITAl: � InDeNlM OTMER � NureinqFbrrh . -.- Be FAC�LITV-N�ms /nnorMSirtu�bn.yivss�roerarMnumNq � EROu�p�tl�m � M�M�ne� . St. Francis Medical Center ❑ °OA ❑ 01hi�SDSCN' Bt CITV TOWN OR LOCATION OF DEATH Ed.INSIDE CITV LIMITS Be.COUNTV Oi DEATH Grand Island v.. � No ❑ Hall 9� RESIDENCE-STATE 9b.COUNTV 9t.CITV.TOWN OR IOCATION 9d.STREET AND NUMBER lMeluOinpZfpCaoYl W INSIDE CITV IIMIT9 Nebraska Hall Grand Island 1131 S. Cherry 68801 �«� �❑ 10 RACE-(e.q.,WhBa.Black Amsnean Mitlian, 11.ANCESTRV le.q.,Mallea Mexiean.Oe�m�n.N�) 12.�MARPIEO a NtlDOWED 13 NAME OF SPWSE IM wrN.pv�m�MM��1 eR.IlSoec�Nl ISpecity� NEVER DIVORCED d White American Esther Kutschkau � 1�e USUAL OCCUPATION IGiva kind ol work done dudng mosf 14b KIND OF BUSINESS INDUSTRY 15.EDUCATION �Spec�N ony nph�h prw�comp»roe1 U d wark�ng lile.even ilrenredl � EbmsMSry a SeeorMery 10��21 ColNqa n.�a 5•i Chief Wharfinger City Of Long Beach, CA. 12th Grade C �6.FA7HER-NAME FNiST MIDDIE LAST 17.MOTNER FIRST MIODLE MAIDEN SURNAME � : Thomas Mertz Danaher Blanche NMN McClure O • t8 Wn5 DECEASED EvER W U.S.ARMED FORCES? 19a.INFORMANT-NAME C IveY e s��k.� Ilf a.give w�r�nA datea d asrviasa� �-4-1941-12-15-1960 Esther Danaher - Wife � 19b INFORMANT MAILIN�ADDRESS ISTREET OR R.iD.NO..CI1V OR TOWN.STATE.IIP� � 1131 S. Cherry, Grand Island, Nebraska 68801 � 20.EMBALMER-SIONATURE6LICENSENO. 21e.METH000FDISPOSITION 21D.DAiE 21a CEMETERYORCREMAipav NAME U Z � Jul 12, 1999 Central Ne. Cremation Serv. � Not Embalmed ❑�„�s� �Femovai QC 22e FUNEHAI HOME�NAME 21E.CEMETERV OR CREMAiOAV LOCATION CITV OA TOWN STATE w � Livinpston-Sondermann F.H. �0reine1on ❑°onato" Gibbon, Nebraska W j� 22b FUNERAI OME ADORESS ISTREET OR R.F.D.NO_CITV OR TOWN.STATE,21�) 0 L ,� a 601 N. Webb Road, Grand Island, Nebraska 68803-4050 T � a 23. iE CAUSE q IENTER ONLV ONE CAUSE PER LINE FOR lal.lbl.AND�cl) � �^b'O��^01i��'b�QrP` � j PAH� CRAI �I/ '�^� I �. I Q lel � DUE TO�R AS A CONSEOUENCE OF / kharval pelw�n on�an0 neam C7 LL / �DI L/L,� �„�?�C.�' �/VI �� ./.�C v�-�c.ac�� i � DUE TO.OR AS A CONSEOUENCE OF � h+NrvN Eelwe�e ontM�nA oeam I I (C) � OTHER SIGNIFICANT CONDITIONS�Cond�ions contribuling to Ma tleaM bul ral relete0 PAFT 111 IF FEMALE.WAS THERE A 2� AUTOPS� 25.WAS CASE REfERRED TO MEDICAL PART PREGNANCY IN TME PAST 3 MONTHS? � EXAMINER OR CORONER� II (Ages10-S11 Ves No Vae No V�s No 26a 28b.DATE OF INJURV �MO..Day.Yc) 26c.HOUR OF INJURV 28A.DESCRIBE HOW INJUPV OCCUiif7ED � Accidern � UnAeiermine0 M � Swode � Pentlmq 28a INJURY AT WORK 261.P�,AC�QF�RV�N Iqn�e,term.sheel.f�cbry 2Eg.IOCAiION STREET OR R.f.D.NO. CITV OR TOWN ST�TE o we iMfi ek SO�pll � Momicide ��vesfigation Yea� No� 27a OATE OF DEATH /Ab DeY�Yr) 28e DRTE SIONEO /Mo..Onv YrJ 2Sb TiME OF DEATH � b� July 11, 1999 6 M � 27b �ATE SIONED lMo.Day,Yr1 27c.TIME OF DEATH �� 2Bt.PRpNOUNCED DEAD lAb..Day.YrJ 2EE.PRpNOUNCED DEAD /hburr g�� 'J�ul 12, 99 11:13 AM M � �� M � �� 27A.To tne betl ol my nowl .deat�occu.red�e Nme.date daee snd due to Ihe �� 2Be.On 1ha bul�d aM�rtdnatan�ntl or Y�vsenp�lion.in my opimon d��m oeewrW N 'c9yselsl s�atee. / / � Me tima,MM end dKa anE Aus ro M»c�ueNs�st�A. X � 151 nature anC T� �� Mws�n0 TIIN 29 DID TOBACCO USE CO FIBUT TO THE OEATHO HAS OROAN OR TISSUE DONATION BEEN CON$IDERED? 30.b WA3 CON9ENT ORANTED� Y� VES "NO UNKNOWN � VES NO � �ES NO ,� 3i NAME AND A��nF CERTIFIEA IP SICIAN,CORONER-5 PHVSICIAN OR COUNTV ATtORNEVI lTyps a Pn John A Wa oner Jr MD, 800 Alpha Street, Grand Island, Ne 68803 32a REGISTRAR 32b.DAiE FILED BV REGISTRAR (MO..Day.Yr.� FOR VITAL STATISTICS USE ONLY Place.......................A................................B................................C................................D................................E................................Part II......................TMV........................... NSC...................................................................................:...............................................................................................................................................................Census Tract No. Work......................................................................................................................................................................................................................................................................................... UC..........................................................................................................................................................................:............................................................................... Reject.................................................................................................................................................................................................................................................. �v,i�ae rnn�or��w on ncr��b o�w�A LEGAL DESCRIPTION: The South Twelve feet (S12' ) of Lot Forty-Nine (49) and all of Lot Forty-Eight (48) , Fonner View Subdivision, in the City of Grand Island, Hall County, Nebraska. . �� , '2d , , i.. . � - ,:. .i. � �;;':;�?� `I� .. , . _.. I hereby cer"`. ��s �: .;_ _ . ��. � � o- y 1 �. .. .__... State of �a:,�, ,�. _. , �, _ --_----.�..�__ � , „ `:.vR'� �. .. . � - , � ..-, . �c�>�1��`-� , --- `"- as ;a. }�9 �� ' ° Y�;: �-,_�� Signed in my preser�e ,� ----.._._..-___.__. _ �d��ary PubL�C