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<br /> LOT THIRTY-SEVEN (37) IN BLOCK "D" IN PARKVIEW SUBDIVISION, IN THE CITY �
<br /> OF GRAND ISLAND, HALL �'0'u':.TY. NEBP.ASI��
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<br /> WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA��AT�
<br /> DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A��itU]��E��
<br /> OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPt�R ��V,� � �H
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DF.p�d�O12Y .�'.fi�t .,�-
<br /> VITAL RECORUS. �^ - : ,.-s
<br /> -..- A ,,•� „.� '
<br /> DATE OF ISSUANCE � ,�y.`:
<br /> � �A����
<br /> �EB 1 19� STANLEY S.. ;�0��+.;���`.�
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<br /> LINCOLN, NEBRASKA ' BUREAU OF VITAI���A�S��CS
<br /> 99 11147 �,
<br /> _ --._.
<br /> STATE OF NESRASKA-DEPARTMEMT OF NEALTH
<br /> SUREAU Of VITAL STATISTICS p`' � n �� �
<br /> CERTIFICATE OF DEATH�. � o o ;� ,j
<br /> DECEDENT-N�E i�RST MIDOIE lw Ex D�TE DE�TM(MO.,Dar,r..1
<br /> , Lee Edward Lubeck zMale � November 30 1986
<br /> RACE-(�.q..WAir�,lloc►,Am�rKOn ORIGIN/DESCFNT(�.p.,IreGan,M�■icow, AGE-�..,��..wer UNDER 1 YEAR UNDER 1 DA1' DATE Oi SIRTM(Mo.,Dor,Yr.�
<br /> Indian,�k.)(Sp�ailr) G�nnae,�hJ(Sp�tilrl ( (Yn.) MOS. � DAYS NOURS� MINS.
<br /> . White s American (; � e,. 56 eb. e� � ,March 12 1930
<br /> CITT ANO STATE Oi lIRTM�N�w�ln U.S.A„ CItIZEN Of WMA�COUNTRY MARRIED,HEVER hURMED, NAME OF 510USE(Il.il�,pi.�Tnid�n nom�l
<br /> eo�counn�/ WIDOWED.DIVORCED(SP�cil�l
<br /> e Harlan Count Nebraska v U.S.A. �o. Married �� Gwen R. Christiansen
<br /> SOCIAI SfCURITY NUMlER USU�I OC�U►ATION(G�.�k��d el.o.1 don�du•�np�ne�� KtNO 0/6USiNESS OR INDUST�Y COUNTY OF DEATM
<br /> ol.orkl�y fil..�.•n�l.N�.�d) /
<br /> ,� 506-26-0939 ,3a District Office M r. D��� ,ab Construct`ion Co �.a Douglas
<br /> CITY,TOWN OR IOCATION Of DEATM INSIDE CITY IIMITS NOS�ITAI OR OTNER INSTITUTION-Nen» (1/ne�in�ilA�r, ��NOS►.O�INSi i�d��o�•DO�,
<br /> (Sp�ai! Y�t or No/ pir��b N ond numb r OV�yari�nqt�r �w�.I�pan•��/Sp�.,l�l
<br /> ,�b Omaha ,k. �es ,� �ergan 'hfercy Hospital 14� Inpatient
<br /> RESIDENCE-STATE COUNTY CIP/,TOWN OR IOCATION STREET AND NUM6E� INSIDE CITY IIMITS
<br /> ,,, Nebraska „b Hall ,k. Grand Isla�d ,sd. 2522 Pioneer Blvd ;se"'�'e's`N'�
<br /> AtMER-NAME i1R T MIOOIE UST MOTNER-hU1DENNAME FIRSi MIODIE LA T
<br /> ,6 Otto T. Lubeck �� Stella M. King
<br /> WAS DECEASED EVER IN U.S. ARMED FORCES7 INFORMANT-NAME-REUTIONSMIi-hUiIING ADORESS 1ST�fFT O�R.f D.HO_CIT'O�TOwN,S1ATt,IV)
<br /> (��..no.o. n�lI_11/���.q�.y.�ar ond dar��ol��..�<�1 68g O 1
<br /> �eYes: y-20-51 6-19-53 ,v�wen R. Lubeck-Wife-2522 Pi�neer Blvd.-Grand Island, NE.
<br /> BURIAI,C.amat�on,Remo.al DATE CEMETERY OR CREMATORY-NAME IOCATION GIiY OR TOWN STATE
<br /> Burial Dec. 3, 1986 Grand Island Cemeter Grand Island NE.
<br /> zoa. zoe aa Y �od. �
<br /> EM6AlMER-SIGNATURE 6 IICEN$f NO. f ENAI MOME- A E ND RE (STR i O �.�D r+ �tv O TOM�N,SiAiE.II►1
<br /> , i �`r'wanson-G�'oYd''en'�'or�Euary f�ma"ha, RJ� �or
<br /> z1 � �, �z,Apfel-Butler-Geddes 1123 W. 2nd, Grand Island, NE. 68801
<br /> DATE Oi OEATH(Ab.,Da�,Y../ OATE SIGNED(Mo.Dar,Y..) MOUR Of DEATM
<br /> ai ��i
<br /> gy u,. =�o z�,.12-11-86 sab. 2 :24 • --""
<br /> .> DA1E SIGNED(Mo.,Doy,Yr.) MOUR OF DEATM !z�} PRONOUNCEDDfAD iRONOUNCEDDEAD(Hou.)
<br /> ��Z oh�� (Mo..Da ,Y..)
<br /> z�b. �k M �W; zk. �1-30-86 z4 . 2 :24 . M
<br /> a� ie tM bn�d�y Inw.l�dq�.d�orA«a�..�d er rM K�w•,dah a�d pl«�md du��e M� E�O On M�bo.i�ol�.omino�isn w�iqa�ion.in r epinie d�aM n�d or
<br /> e= o�.N4�ror.a ��� rA•HT..dor•e�d pl«•e d�• eu..1q ior�d.
<br /> t � `�e
<br /> 2Jd.lS�qnor�r�and Ti�l�l• � 24�.lSiynohr�ond/�N�l.
<br /> NAME ANO AODRESS Of CERTIfIER(VMYSICIAN,CQI�Q�R'S��jClA/i,Q�UNTY ATTORNEV)(iyp�or VrinlJ
<br /> Lc Z Yll
<br /> 13 Blaine Y. Roffman, M. . , 105 Nozth 37th Omaha NE. 68131
<br /> REGISTRAN /� �_ � (,/f DATE RECEIVED SY REGISTRAR(Mo.,Day,Y..)
<br /> ���,��f� L� �`�_ �� x /y �`_�, � (�QQ
<br /> 76a.fS�ynor�nl��...��,,."-� °w�//0-+��� � •�"1 ° 26b. ��-•J a? 1JUV
<br /> 27. IMMEDIA7E CAUSE . (FNiER ONIY ONE C E I FOR(o),O,AND(c1) � i�r...oi b.r...�om��ond dwM
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<br /> D E TO,OR AS A CONS O NCE Of: , i.,.r.ol 6.r..�n onw�ond dwM
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<br /> OUE TO,OR AS A CONSEQUENGE Of: , 1nh.wl l.r...n o�..�ond d.er►
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<br /> ►ART �TME�SIGNIfICANT CONDITIONS-Cewdiriom aon�.fbv�inp ro dwM b.r ner r.lor�d ►ART 111.If fflMlE,WAS TNFRE A AUTO►Sr WAS CASE�EiEt�lD TO MEWCAI
<br /> 11 ►RFGNANCY IN iM[►AST�MpNiM51 (Sp�ail�1'��o.Ne1 EIAMIHE�OR CORONf�
<br /> (Sp�cilr Yti u Nol
<br /> r..C r+o �i ze Yes �v. Y
<br /> ACCIDfNT,SUICIDf.NOMIC�Df,UNOEi, DATE O�INIURV(MO.,Do�,1'r.) NOUR q IWURY DEXlI�E HOW INIURY OCCUtfED
<br /> W IENWNG�NVESTIG�TION f5p�u/�1
<br /> 700. 706. 10�. M 30d.
<br /> Ir+1Ult��f WOII[ �UCf Of�NIURY-M how.�,lorm.�bwl.bctery, lOUT10N ST�EET O�R.f.D.Ne. CIT'O�TOWN STATE
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