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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br /> 0� AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br /> VITAL RECORDS. - - . -
<br /> DAT OF IS U�AcNfCE ��`���
<br /> '�AY � 1a� STA�LE3�-S. GOOPEI�,�``D�#tECTOR
<br /> LINCOLN, NEBRASKA BUR�A�3 .0� VITAL _�TAT�TICS
<br /> 9 9 1114 3 9 =-��- - --==-
<br /> STATE OF NEBRASKA-DEPARTMEN'f OF HEALTH ��
<br /> sun�►u oFVrr��sTnTisncs 9 3 �� 7 2�
<br /> CERTIFICATE OF��►TH � �•. �� '
<br /> 1.DECEDENT-NAME FIRST MIDDLE UST 2.SE% 3.DATE OF DEATii (MOntlr,Day,Ywr/
<br /> James Mich�ei Hanr�on Male Janua 19, 1993
<br /> �l.CITV AND STATE Of&RTM /tl nOf in U.S.A.,nam�COUnby) SY.AOE-lut BiNW�y � 8.DATE OF BIRTX (AbnYt O�y,YNr)
<br /> 1 (V�i.� 50. MOS.� DAVS 5C.HOURS� MINS.
<br /> Omaha, Nebraska � 57 ; ; Februa 12, 1935
<br /> 7.$OCIAL SECURITV NUMBEF 8s.PUCE OF DUTM
<br /> HOSPITAL: �IrpWeM ❑ERIOulpatierX ❑DOA
<br /> 505-48-6834 ` TMER: ❑Nunirp Hom� ❑Rssidencs ❑OthM(Spseify/
<br /> � BE.FAGUTV-Nun� /M nd irrtlMion,piw sheN anC numDsr/ 8c.CITV,TOWN OR LOCATION OF DEATH Bd.INSIDE CITV LIMITS 8�.CAUNTY OF DEATM
<br /> /Spciry Y�s a No1
<br /> St. Francis Medical Center Grand Island Yes Hall
<br /> 9�RESIDENCE-STATE 9b.COUNTV 9c.CITV.TOWN OR IOCATION 9A.STREET ANO NUMBER /Ineludng Zip CoW) 9�.INSIDE CITV LIMRS
<br /> /Sp�eHy Ya a Nc)
<br /> Nebraska Hall Grand Island 1515 W. John Yes
<br /> 10.MCE-(�.q.,NTM.B4ck Am�ric�n IndNn. 11.ANCESTRV��.p.,MaF�n.AMxiean,axm�n,sle.� 12.MARHIED.NEVER MARRIED, t3.NAME OF SPOUSE /M wils,piw m�iMn n�ml)
<br /> �.)/S� lte (SW��N/ WIDOWED.DIVORCEO(SpetAy/
<br /> WC1 American � Married Lois White
<br /> t4a.USUAI OCCUPATION(Giw kmd d wak EorN Owiny mwf trb.KIND OF BUSINESS INOUSTRV
<br /> d Farmer�� ��� Agriculture ��� ENm�rnaryaSreond�ry�0-t2� i cawy.ii-aas��
<br /> 16.FATHER-NAME FiRST MIODLE UST 17.MOTHER-MAIOEN NAME iIRST MIDDLE UST
<br /> Daniel B. Hannon Elizabeth Moore
<br /> 18.WAS OECEASED EVEA IN U.S.ARMED FORCES? 19.INfOfiMANT-NAME-MAILING ADDRESS (STREET OR R.F.D.NO.,CITV OR TOWN,STATE.ZIP�
<br /> �Ves,ra.a wik.l (M y�s.9iw war uW dN�a W esrvicu)
<br /> No Lois Hannon-1515 W. John-Grand Island, NE. 68801
<br /> 20t BURtAI,Crom�tion,R«noval, . ZOb.OATE ZOe.CEMETERY OR CREMATORY•NAME 20d.LOCATION CRY OR TOWN STATE
<br /> Dona6on
<br /> Burial Jan. 23, 1993 St. Mary's Catholic Cemet Wood River, Nebraska
<br /> 21.E ER-SIGNA�RE 4�tJCE NO. �/�� 22.fUNERAL MOME-NAME AND ADDRESS �STREET OR R.F.D.NO.,CRY OR TOWN,STATE,ZIP�
<br /> A fel-Butler-Geddes 1123 W. 2nd, Grand Island, NE.68801
<br /> 23.` IM EDI TE IENTER ONLV ONE CAUSE PEH LINE FOR(a�.�E�,AND�e�) i IMarval betwwn oneet anC Ae�M
<br /> PART /� ' ' I �� ,q
<br /> � l�l �.I.CkI ,.,(�,c_i r_�� I /J�
<br /> v�w�.v
<br /> DUE TO,O AS A CONSEWENCE OF: i imarval Det�wsen onset aM AsaM
<br /> � ��IJiI.LVf��t.t./�'' , I
<br /> � 3�`�
<br /> �
<br /> DUE T0,OR AS A CONSEQUENCE OF: I Imerval beMeen onssl anC MaM
<br /> �ln;�l..� L�l.( (,G�/'.�r''�1n� �y ' u�2�'M� 7 ��1•
<br /> OTHER SIGNIFICANT CONDITIONS-CaWitla�s CoMriDulinp b Matli ON nd relBtsC PART III IF FEMALE,WAS THERE A 21.AUTOVSY 25.WAS CASE REFEHRED TO MEDICAI
<br /> PART PREGNANCY IN THE PAST 3 MONTHS? /Spoc Yss W Nol EXAMINER OR CORONER?
<br /> �� �'� «��.,a�� va
<br /> v.s❑ r�❑
<br /> 28a.ACCIDENT,SUICIDE,HOMICIDE,UNDET., 28b.DATE OF INJURV (i1b.,Dey,Yi.J 28t.HOUR OF INJURV 28d.DESCRIBE HOW INJURY OCCURRED
<br /> OR PENDING INVESTIGATION /Specily)
<br /> 28e.INJURY AT WORK 26f.PUCE OF INJURY-At hana,hrm,Msel hebry. 28q.LOCATION STREET OR R.F.D.H0. CITV OR TOWN STATE
<br /> (SPk�A'Y�a a Nol oKa�buibirp,�tc. ISM�MI
<br /> 27a.DATE OF DEATM /Ab.,Wy,Yr.J 28�.OATE SIGNED (MO..Day,Yr.) 28b.TIME OF DEATH
<br /> January 19, 1993 a
<br /> �a� 270.DATE SIGNED (MO.,Day,Yc/ 27a TIME Of DEATM ��� 2Bc.PRONOUNCED DEAD (Ab..Qty,Yr.l 28tl.PRONOUNCED DEAD (HaurJ
<br /> �� � ZL���3 (D.�S /�� `�
<br /> E� 27tl.TO IM DM d my knOwl�Op�.M�N octun�0�t iM E'M.Aab�rW W�n�nO Ow 00 ihs o � 28�.On ms Wais d szam�nuan an0 a invee0qatwn.in my oqnion Os�th occurrs0 ai
<br /> cawNsl wwE. //� ��e d+a t�ma,Ene aM Wsce ano oua w tne cauaslsl euuC.
<br /> aM Ti1N► �"""`'�� � � Si naNro�nE Titls
<br /> 2Ba DID TOBACCO USE CANTRIBUTE TO TME DEATM? 30�.HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? 30D WAS CONSENT GMNTED?
<br /> VES O NO ❑UNKNOWN ❑VES �O ��ES �1O
<br /> 31.NAME AND ADORESS OF CERTFIER(PMVSICAN,CORONER'S PMVSICAN OR COUNTY ATTORNEV� (Typ�a Pnnt)
<br /> Kathy Mo e M.D. 72 N. Custer, Grand Island, NE. 68803
<br /> 32a.REGISTMR 32D ���I�4�� VGiSj�./`/ .DIY,Vr.)
<br /> IY y
<br /> i
<br /> � � - __ �,,. �
<br /> ., yJ
<br /> I,F:�'AL PF,SCpTT'TT��T; Lot Three (31 , in Block �'ortv-one (411 , T'artiv in Charles
<br /> �•]asmer's Addition and Dartiv in Charles T•Tasmer's Second Ad.dition, both beina
<br /> Additions to the citv of ('rand Island, uall County, rTebraska.
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