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<br /> LOT ELEVEN (11) , CAPITAL HEIGHTS SIXTH SUBDIVISION, CITY OF GRAND
<br /> ISLAND, HALL COUNTY, NEBRASKA
<br /> �S��
<br /> WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO �E4�°TRU� COPY
<br /> OF AN ORIGINAL RECORD ON- FILE WITH THE STATE �EpA�j�IF.�T��;ET�'��IEAL�g
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LEGA�'%$�Pb,S��,OR'�'��'pR �
<br /> VITAL RECORDS. , >°'.' � : � '�� L�`,
<br /> q`�-/D 9"/��' . `` � � j
<br /> d. ; ; '�� . �,s� .
<br /> DATE OF ISSUANCE � �� '
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<br /> SEP 31985' � sT�.rii��'S.,^COOPEB;s . �CTOR
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<br /> LINCOLN, NEBRASKA BUREAIT"�y"b�`'+��#�'�,��TTA�'�'STICS
<br /> °�. .,�.. -
<br /> �
<br /> STATE OF NEBRASKA-DEPARTMENT OF HEALTH
<br /> Amended September 3, 1985 BUREAU OF ViTAI STATISTICS
<br /> CERTIFICATE OF DEATH —
<br /> DECEDENT—NAME fIRST MIDDIE IAST SEX pATE Of OEATH(MO.,Dor,Y..)
<br /> �. Bill Beau Guyette zMale � August i�, i9$5
<br /> RACE—(�.g.,WAi�e,lloc4,Am�rican ORIGIN/DESCENT(�.y.,Itolian,M�i�can, AGE—b•rs�nAdor UNDfR 1 YEAR UNDER 1 DAY OATEOFSIRTM(Mo.,Day,Yr.�
<br /> Indion,�k.)(Sp�ci/r) C»r1non,�tc.)(SpKi/r) � � (yr�,) 57 MOS. � DAYS MOURS� MINS.
<br /> .. White s. American � ' ' �Jan. 13, 1928
<br /> CITY AND STATE OF SIRTH(1/nol in U.S.A., CITIZEN Of WHAT COUNTRY MARRIED,NEVER MARRIED, � ,
<br /> norrr�counlryJ NAME Of S►OUSE(1/ril�,gi.�/ne�d�n nom�)
<br /> Grand Island Nebraska W��WED,DIVORCED Sp�ci/y)
<br /> e � 9. U.S.A. ,o Marrie� „ Donna R. Hayman
<br /> SOCIAI SECURITI'NUMSER USUAL OCCUVATION(Gir�kind o!work don�du.fng mod KIND OF SUSINESS OR INDUSTRY COUNTY Of DEATM
<br /> 5�7� � 70 o/wo.king 6l�,�.�n nfir�d)
<br /> 12 �aa. Owner�Operator „b Glass Company , Hall
<br /> CITY,TOWN OR LOCATION Oi DEATH �O�
<br /> INSIDE CITY LIMITS MOSPITAL OR OTMER INSTITUTION—Nome(1/no�in�ilA��, If Mp5►.OR INST.Indico4 OO�,
<br /> (Sp�cify 1'�i o•No) yir�dr • n numb�r Ourpari�nyEnw..R�n.Inperi�nr lSpK�lrl
<br /> „b. Grand Island ,k. No „d ��3� In�ependence Ave. ----
<br /> RESIDENCE—STATE COUNTY ��'�
<br /> CITT,TOWN OR IOCATION STREET AND NUMlER INSIDE CITY IIMITS
<br /> ,so. Nebraska ,sb. Hall ,x. Grand Island ,sa. 2830 Independence Ave �SP"'�r�'o°'N°'
<br /> fATMER—NAME fIRST MIDOLE UST MOTHER—MAIDEN NAME fIRST �S� --
<br /> MIDDIE UST
<br /> ,6. Clarence J. Guyette „ Mary --- Vineyard
<br /> WAS DECEASED EVER IN U.S.ARMED fORCE54 INFORMANT—NAME—RELATIONSMIV—MAII�NG ADDRESS
<br /> (Y��,ne,or�nY) 11/y��,y�r��.er ond doi��01 w.ric�) (SiREFi OR R.F.D.NO.,CITY OR lOWN,STATE,21►)
<br /> ,s. Yes: 12-3-45 5-15-58 ,QDonna R. Guyette-Wife-2830 Independence AveNEGran��Island
<br /> BURIAI,Cremotion,RemovalDATE CEMETERYORCREMUTORY—NAME IOCATION CITYpRTOWN STATE
<br /> �oa. Burial z0b ug. 16, 1985 z� Westlawn Memorial Park zod Grand Island, NE
<br /> `/1%+1l�}MER—SfGNATURE 6 Ll�sE N,p���.3 C� iUNERAI NOME—NAMf AND ADDRF55 (STREEi Ot R.F.O.NO..C�T1'O�TOWN.STATl.II►1
<br /> t �'K G
<br /> z?Apfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.68801
<br /> D E OF OEATM(Me.,Day,Yr.) DATE SIGNED(Mo.Doy,Yr.) MOUR OF DEATM
<br /> Z>
<br /> " ''= 8�22�85 between 10 : 30 a.m.
<br /> �v 29a. v V r �Ia.
<br /> .> D�TE S�GNED(Mo.,Dar.r•/ MOUR Of DE�iH ;>C — ��b' ' M
<br /> E� o�t� PRONOUNCEO DEAD PRONOUNCED DEAD(Hour
<br /> E � (Mo.,Dor.Yr.�
<br /> �� 236. I27c. ,N ��.
<br /> �° Z�� 4tc. 24 U.
<br /> Te�M bn�ol mr►nc.r��dp�.dw+A occumd et rh�ri1w�,doe�ond lo<•ond dw ro�b a ' '
<br /> F< <ou�Q�bNd. P o�Ov On M�be�i�ef�.aTino�ion and/e.ie.nriyo�ien,in y opinion d�oM xavn�d ar
<br /> „�e rM liw,daN and ploa�and dw ro,M� uw(�)�1aNd. �
<br /> Y3d./s�p�a��..o�d t;H.l� " � o�o
<br /> NAME AND AODRE55 OF CERTIFIER(PMYSICIAN,CORONER'S iMYSICIAN OR COUNTY ATTORNEY�(1 SI ��n and TiM�)� �'"�'���.-i� �� :�a, �. c-.
<br /> ) yp�or C•inl)
<br /> ' zs. Linda Caster Senff De ut Hall County Attorney
<br /> REGISTRAR
<br /> �� //j DATE RECE ED BY REGISTRAR(Mo.,Dor,Y..) ��11
<br /> 26o./S�pnahn/.C// �L"�.� ,�,� �'aLP �� /(���
<br /> 27. IMMEDIATE CAUSE 266. /
<br /> PART (EN1ER ONLY ONE CAUSE VER LINf fOR(o),( J,AND(c)) � e,r.,,ml b•rw.�o,,..r ond dwM
<br /> io, qunshot wound to head ;
<br /> DUE TO OR AS A CONSEOUEN�E Of �
<br /> � Inhr.rol bMr��n on�ond dwrA
<br /> (b)
<br /> OUE TO OR AS A CONSEOUENCE OF: --- �
<br /> Inr�r.ol b�MM on���end dweh
<br /> ld
<br /> VART OTHR SIGNIFICANi CONDITIONS—Condirion.ionr.iburinp b dwrh bur nor.•lor�d 1ART 111.IF fEMAtE.WAS iMERE A AUTO►SY
<br /> WAS CASE REfE�RED TO MEDICAI
<br /> II GfFGNANCY IN TME PAST]MpNTNS'7 (Sp�cilr 1'��or Ne) EXAMINER O�CO�OHER
<br /> (SpKil�Yn o�No)
<br /> Y••° "� ❑ �e. no zv. e s
<br /> ACCIDENT.SUKIDE,MOAUCIDE,UNDEi, DAif Of IN1U�Y(MO.,Do�•1'•.1 HOUR Of RuUR� DESCRUE MOw iN1URY OCCURRED
<br /> OR/ENqNG IMVESTIG�.TI N (Sp�a;lr) �
<br /> ,o, suicic�e i�b 8/15/�5 5��4b s�lf-�in�flieted gunshot wound
<br /> -- _— i�«: M 30d. O hea -
<br /> INIU�Y AT Wp�1I � �T►IACE Of INIURY—��Aoww,loriw,�1rMt,foclory. �� IOCATION STtEET O��.f.D.Ne. � CIiY O�TOWN STATE
<br /> rsP«;r,r„„r�� or���.e„ad��o,«< tso.�;r�� 2�3� IIl(3-G'D22'1C�E'.Il�� AVe.
<br /> ,a. no __ ,or. home __ _ Iaog. rand 1sYanci,
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