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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 Tp.,B�'r A_TRUE COPY
<br /> OF AN ORIGINAL RECORD ON FILE WITH THE STATE bERARTMENT OF HEALTH
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LF.f��L DEPOSITbRY FOR �
<br /> VITAL RECORDS. ��.• - ' ---- c�
<br /> �---- -� . �?
<br /> 99 1 � +� �99' � ��
<br /> DATE OF ISSUANCE �G�D�I►'""�
<br /> JUN 2 21987 S`��LEY S. COO�ER,- DIRECTOR
<br /> LINCOLN, NEBRASKA A BUREAU •OF VIT�1L STATISTICS
<br /> STATE OF NEBRASKA-DEPARTMENT OF HEALTN
<br /> BUREAU OF VITAL STATISTICS
<br /> CERTIFICATE OF DEATH
<br /> DECFDENT-NAME FIRST MIDDIE UST SEX DAiE OF DEATM(Mo., Doy,Yr.�
<br /> , Leonard John Walklin zMale I� June 13, 1987
<br /> R.�CE-(•g., wti�re, 61ack, �m•.ew� qtIGIN/OESCENT(�.g.,leal�oo,/a..1co�, AGE-io.�e��wor UNDER t vE�R UNDER l D�v D�TE O iHf BIR /Mo.,Doy,r..�
<br /> i�d�o�,.k.l(Sp�c�ly) G�nnan,NcJ($p�cily) (yn.) MOS. DAY$ NOURS, MINS
<br /> . White s American I,a 79 ab � 1,Nov. 6, 1907
<br /> CITY ANO STATE OF SIRTM(I!not�n U.S.A, QTIZEN Of WMAT COUNTRY MARRIEO,NEVER MARRIED, I NAME OF S►OUSE(If wif�,gir�moid�n no�n�)
<br /> no�coun�.rl WIOOWED,OIVORCED(Sp�ci/y)
<br /> e Crete, Nebraska 9 U.S.A. ,o Married „Gladys Schmedemann
<br /> SOCIAt SECURITY NUMSER USUAL OGCUPATION(Gi.�kind ol work don�dur�ng mo�� KIND OF BUSINESS ON INDUSiRY COUNTV OF DEATM
<br /> ol.�or4i�g Lf�,�.�n H ro�ind)
<br /> _ �z 508-38-1839 ,ao Pharmacist (Retired) „bWalklin Pharmac}�,�, Lancaster
<br /> CITY.TOWN OR lOUT10N OF DEATH INSIDE CITY UMITS I HOSPITAI OR OTMER INSTITUTION-Nome (1lnor I�eilA�r, IF MOS► O��NSt i�daor.oO�,
<br /> (Sp��ily Y��or No/ gi.��h�N ond numb�r) O��part�nr�E�w.. Rm.�npo��•,.r lSP�,IrI
<br /> ,.b Lincoln ,k Yes ,.d St. Elizabeth Hospital „e. D.O.A.
<br /> �ESIDENCE-STATE COUNTY I CITY.TOWN OR IOCATION STREET AND NUM6ER INSIDE CITY lIM1T5
<br /> �saNebraska ,sb Hall � �S`������'es N�'
<br /> � ,�s< Grand Island ,sd 408 S. Arthur ,s�
<br /> �fATMER-NAME FIRST MIDDIE UST MOTHER-MAIDENNAME FlRST MIDOIE UST �
<br /> `„_ John William Walklin l,, Lorena --- McNamara
<br /> � WAS DECEASED EVER IN U 5. ARMED FORCE59 j INFORMANT-�NAME--REUTIONSMIV-MAIUNG ADDRESS (ST�EF1 OR R F D NO.UT'OR TOM'N,SiATE,ZI►)
<br /> ,v,.� o.���) 1��re�.y�.e..e.a�d eare,o�.e..,�rl j
<br /> � ,e No i,9Gladys Walklin-Wife-408 S. Arthur-Grand Island, NE.68801
<br /> BURIAI,Cremat�on,Remo.al OATE � �CFMETERY OR CREhUTORY-NM1E IOCATION CITY OR TOWN STATE
<br /> June 16, 1987 !
<br /> zo,. Burial zob �a Grand Island Cemeter �od Grand Island, Nebraska
<br /> EMlALMER-SIGNATURF UCENSE NO. I FUNERAI HOME-NAME AND ADORESS �STREET OR N f D NO,ON OR TpwN,STATF,ZIV�
<br /> z� ��-���,,; ��333 'z2Apfe1-Butler-Geddes 1123 W. 2nd, Grand Island, NE. 68801
<br /> (Mo, Do�, Y..) � Z T DATE SIGNED(Mo. Day.Yr.)
<br /> GATE Of D A i MOUR Of DEATM
<br /> �
<br /> �!
<br /> a� z�e ' � - l 3 ' � �To �.o Iz.b M
<br /> pz_ iDAiE S�Gr:JFC;�::o.,Dor, �r.i -T`4CUR C� ^E,�TN as�� PRONOUNCEDDEAD —PRONOVNCEDDEAO(Mov.l
<br /> �ac7 /_ �--"- ���/J t o'^�e (Mo.,Doy,Yr.l
<br /> v< 2�b. l� �� / 23c. 1�:2� M �W Z 24c. Z� . M
<br /> �; To�M b•.r ol�nr k�w.l.dp•,d•o�6«<�..•d A•��Te,do�•o�d plou a�d d�.re r6. a Z O p„r�,bm�.01•.oT��o��o�o�d - r r p���o�
<br /> .o. n.�.iQO�oo in iny o d.arA occu..•d or
<br /> F i aa�.�(�)�ro��d. o s� �6.nm�,dar•a�d plx�md d� ro M�< �w(�).ra��d
<br /> /L.G'�� �'� '"°s
<br /> 2Jd.fi�y,.o��..o�d ra.i� V'�� Y�..ts;9„o�,,..o�d r;��.t�
<br /> NAME AND ADORESS Of CERTIFIER( YSICIAN,CORONER'S VMYSICIAN OR COUNTY ATTORNEY)(Typ�or YrinlJ
<br /> ZS S. F. Nabity M.D. 44 F idley Grand Island, Nebraska 68803
<br /> �REGISTRAR DATE RECEIVED BY NFGISTRAR(Mo.,Doy,Yi.)
<br /> ;z� �s,9�o,�..�► . � z66 J U N 2 2 1987
<br /> Z7. IMMEDIATE CAUSE � (EN1ER ONLY ONE C1USE VER IINE FOR(o),(b1,AND(c)) r I�r�..al b�r.+��e o�w�md d�orh
<br /> PART L� � � �f �
<br /> � / �-c,a,.c�-�-c-� ��� C�t�,,�`c-a,�-.. c2_�..-C-� �w �r.,-_���_
<br /> i,� . .
<br /> —�----- —
<br /> DUE TO, OR AS A�ONS// UENCE OF: /T , Inr�nel b�n.��n o.�.��ond d�orA
<br /> 1bI .'/'���:...,._..�-✓ �C^t��'.__ �'�-ZlI�L.-Y�... --_ l..-�L,�.�.w�.� � ����.'""�.,! �-J/l�J .
<br /> `/ �
<br /> DUE TO,OR AS A CON�pUENCE OF. � �9 .-� � I���nol b�r��n w..�r o�d dwM
<br /> 1�1 �y��^-`l.�,C.�-,.,-'�. /'�`t�.tiL-� ' �-a..�.LL. � �`L��L�_-v', ' /L.7 .
<br /> /
<br /> VART OTME�SIGNIfICANT COMDITIONS-Cond��ion.con bvf�nq ro d•orti bu�ne1 or•d ►ART 111.IF iEMAIE.WAS TNfRf A AUtO►SY wAS CAS IIEfE��ED TO MfD1CAl
<br /> �� � � � A/ Y�EGNANC7 IN TME PAST�MONTMS� (Sp�cill 1'��or„Ne) EJIAMINfR p�CORONER.
<br /> .v���,�.�. �/,.:�� ��- ,. , . � (Sp�<il�Y��or Nol ,/
<br /> Y.ri�`_'rio—r-� 28. ��� 19. N `�% '
<br /> ♦CCIOENT,SU�CIDf,HpAY�IDE,UNDET, DATE Of INIURY(MO..Oa�.Y..1 MOU�OF IWU�Y OESC�IlE NOw INIURT OCCU��ED
<br /> Of/ENdNG INVESTIGATIOM (Sp��rl�l
<br /> 700. I�pb 30c �+ JOd.
<br /> �PUU�Y AT WOR[ � �►IACE Oi INIURY-Ar Ao1w�,leriw,�hN�.�ettery, IOCATION STtEEi OR�F D. No CIT/O�TOWN S1AT!
<br /> lSp�<�1�YN e.No/ �olf�a�b�ild�np.�K.ISp�<il�l
<br /> _ �a --Liot__ �o
<br /> — - _ _-------
<br /> Lot Two (2) except the Westerly Twenty-Six (26) Feet thereof and all of
<br /> Lot One (1) , in Block Nine (9) in Ashton place, an Addition to the City
<br /> of Grand Island, Hall County, IQebraska, as surveyed, platted and recorded. �
<br />
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