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<br /> WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BEI:OW T.p:;B�} -A:TRUE COPY
<br /> OF AN ORIGINAL RECORD ON FILE WITH THE STATE�D�ARfi�sAIT OF HEALTH w�
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE L�►'L�`n�:POSIT(�RY FOR
<br /> VITAL RECORDS. ,.`o=; �' .
<br /> .s 4Y ��I�! ,
<br /> DATE OF ISSUANCE i�`�
<br /> ~�w :�
<br /> JUN 2 21987 s�Ai�i�Y: s..- COb�K,`�DIRECTOR
<br /> ,� ti..�
<br /> LINCOLN, NEBRASKA 9� � t n n�� BUREAUaO$',UY�aL S�ATTSTICS
<br /> lV7
<br /> STATE OF NEBRASKA-DEPARTMENT OF HEALTH
<br /> BUREAU OF VITAL STATISTICS
<br /> CERTIFICATE OF DEATH
<br /> DECEDENT-NAME fIRST MIDDIE lAST SEX DATE OF DEATN(Mo.,Dor,Y..1
<br /> , Leonard John Walklin 2Male � June 13, 1987
<br /> RACE-(�g., Whire,block,Am�ricon ORIGIN/DESCENT(�.q.,Italion,M�aicon, AGE-io.r s�ntido� UNDER 1 YEAR UNDER 1 DAY DATE Of 61R�H(Mo.,Day,Y.J
<br /> Ind�on.�k.)(Sp�cily) G..TO�,•rc.)(Sp«�!y/ (yn.) MOS. � DAYS NOURS� MINS.
<br /> � White S. American �. 79 eb �. �Nov. 6, 1907
<br /> GITY ANO STATE Of SIRTH(1/nol m U.S.A., G�T�ZEN Of WMAT COUNTRY hURRIED,NEVER MARRIED, I NAME OF S►OUSE(IlW�l�,g;.�,no;d.��oT.)
<br /> no��ovn�ry/ M�IDOWED,DIVORGED(Sp�ci/yi
<br /> a. Crete, Nebraska 9 U.S.A. ,o_ Married „Gladys Schmedemann
<br /> SOCIAI SECURITY NUM6ER USUAI OCCUPATION(G�.�k�nd o/.0.4 don�du.�ng rno■r KIND OF SUSINE55 OR INDUSTRY COUNTV Of DEATM
<br /> or.orking Hl�,�r�n i/.Nfnd) Walklin Pharmac
<br /> ,1 508-38-1839 ,�a Pharmacist (Retired) ,�b ,., Lancaster
<br /> CITY.TOWN OR IOCATION Of DEATM INSIDE CITY lIM1T5 MOSPITAL OR OTMER INSTITUTION—Na1ne (If nol in ei�h�r, ��NOS► Ot INST i�d�<o�•DO�,
<br /> (Sp�nly Y�t or No) gir�dr�N ond�umb..) Ovrpari�nyE�w.. ��.Inyar�•�r fSp.e���l
<br /> ,.b Lincoln �k Yes „d. St. Elizabeth Hospital ,.� D.O.A.
<br /> �E510ENCE—STATE COUNTY Cltt.TOwN OR tOCATION STREET AND NUMlER INSIDE CI�Y IIMITS
<br /> uaNebraska ,sb Hall I,k Grand Island ,sa. 408 S. Arthur ;s������es'~�'
<br /> fATMER—NAME FIRST MIDOIF UST MOTMER—MAIDENNAME FIRST MIDDIE LAST �
<br /> 16 John William Walklin �,�. Lorena --- McNamara
<br /> WAS DECEASED EVER IN U 5. ARMED FORCE57 �MFORMANT—NAME--RELATIONSMIO—AUIUNG ADDRESS (STtEET OR!F D r+0.Cltv Ot TOwN,ST�Tf,ZI/I
<br /> ,r•,.„ o���U f�t ro,g�w+a,o�d eores o�sa..�<el
<br /> � ,B No 4�vGladys Walklin-Wife-408 S. Arthur-Grand Island, NE.68801
<br /> rBURUI,Cremolion.Removal DATE � �CEMETERY OR GNEMATORY—NAME IOUTION CITY ON TOWN 51ATE
<br /> June 16, 1987 !
<br /> ��. Burial sob. zo�. Grand Island Cemeter zoa. Grand Island, Nebraska
<br /> EM/ALMER—SIGNATURE IICENSE NO. fUNERAI HOME—NAME AND ADORESS IST�fET OII R.f D NO.C�T'f OR TOM�N.STATF.21►1
<br /> z�.��. �.�,} �.c�2333 _InApfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE. 68801
<br /> OATE Of D A (Mo.,Do�,Yr.) Z� DATE SIGNED(Mo.Do�.Yr.) �MOUR Of DEATM
<br /> � ��Z
<br /> .� zaa. " � - / -3 '� a�o s.a z�b. M
<br /> is OAiE SiGNEO(Mo..Do�,Yr.l —THOUR Of DEATH _ �=C PRONQUNCED DEAD FRONOUNCED DEAO(Mou.l
<br /> �a� o��o (Mo..Doy,rr.J .
<br /> �r c Y3b. � �� �` � � 23c. 1��2� M " � 2ac. 24 . M
<br /> E° To tM b��� f Ty k�o.l.dp•,dw+ti u<urnd M fiTe,dor�and pba�ond d��re rM ��O pn rh�bmi�el• iwineNen d/o.i v�a�iqorion.in r oD���en d�orh«�un�d or
<br /> o� ca���(�)�MNd. F p� �M Y�,dor�ond ploa�ond d��ro M�muw(d�rabd
<br /> F` Y7d.(Sipeoru•�and IiH�)� ��'��" - �� �� 21e.lSiynar�.�ond I1N�)�
<br /> NAME AND AOORESS Of CERTIFIER( YSICIAN.CORONER'S iMY$IC1AN ON COUNTY ATTORNEY)(l�p�or Vrinl)
<br /> zS S. F. Nabity M.D. 44 F idley Grand Island, Nebraska 68803 _
<br /> REGISTRAR DATE RECEIVED BY REGISTRAR(Mo.,Doy,Yr.)
<br /> _ z��5,s�o,�,.�► . � zab J U N 2 2 �
<br /> ' 27. IMME�IATE CAUSE (ENTFR ONLY ONE C USE iER UNE fOR(o),(b1,ANO(cU � Inn�.ol b.n+.•o o�..�o�d dw�A
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<br /> �� � 't-c+-^.l��c-a-� . LLc-7�'___-w-.. �l-�.��� �.M,.. /�`"`.i'T� .
<br /> DUE TO,OR AS A CONS UENCE Of: i 1���no1 b�n+���o�..r o�d d�or6
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<br /> �b� r G, C,GlZ�ti��-G, — L���.,..�. � ��c�..-""�-< yi�� .
<br /> DUE TO,011 AS A CON OUENCE Of: 1 - - � ��r.�.wl b.n..•�o,�.«o�d d.eM
<br /> Y '��,y� i'Lt�.Ci � '`--�tit.%.�-�-t._i%
<br /> �<� -�- �''� .
<br /> iART OTMER SIG NIFICANT COMDITIONS—Cendircen.ce� �bun�p ro dwrh b�r�o� ar�d ►ART III.If iEMAIE,wA5 TNE�E A AUTO►Sr WAS CAS �EfERRlD TO MED1Ul
<br /> 11 . /�L� /�� ►�EGNANCT IN TME►ASi]MpNTN51 (Sp�<i!�1'��or ; EI(AMINER OR CORONl� 7
<br /> U �/ (Sp�il�1��or No)
<br /> '' Y�'r--- 28. C 29. � Si
<br /> ♦CCIDENT,SUICIDE,NOAYCIOE,UNOET, DATf O�INIURY(MO.,Dor,1'r.) MOU�OF IH1Ut1' DfSCM�E NOW INlU�1'OCCURtfO
<br /> Ot IENdNG�NVfSTIGATION (Sp�ulrl
<br /> JOo. �Ob. �Oc. M lOd. —
<br /> �M1U�t AT WO�[ �lAC4 O�INIURY—Ar Ao�,leriw,��rN�,la�rsry. LOCATION STtEEi O�t i D.No. CIT'O�TOWH STAf!
<br /> (Sp�id�YN w Nel eHii�buildmp.Nc.lSp�<ilrl � I
<br /> , aa.--- 1?°r �o . �
<br /> _ ___ - ---- _
<br /> Lot Two (2� except the Westerly Twenty-Six (26) Feet thereof and
<br /> all of Lot One (1) in Ashton Place , an Addition to the City of
<br /> Grand Island, Hall County, Nebraska
<br />
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