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:U <br />m <br />n <br />0 <br />0 <br />M <br />:a <br />N <br />K <br />M <br />�J <br />0 <br />to <br />m <br />-t"9 <br />n co <br />v <br />v <br />z D <br />Male M <br />v <br />C:> <br />T. <br />fTi );I- <br />UNDER 1 DAY 6 <br />6. DATE OF BIRTH /Month. Day. ✓earl <br />MOS. <br />%I` <br />:U <br />m <br />n <br />0 <br />0 <br />M <br />:a <br />N <br />K <br />M <br />�J <br />0 <br />to <br />m <br />-t"9 <br />n co <br />3 Dg.7E OF DE 7H /Month Day. ✓earl <br />r0Una <br />z D <br />Male M <br />March 27, 2002 <br />C:> <br />Pt1 Cn <br />fTi );I- <br />UNDER 1 DAY 6 <br />6. DATE OF BIRTH /Month. Day. ✓earl <br />MOS. <br />%I` <br />Grand Island, Nebraska i <br />(Yrsl 54 Sb. M <br />August 17, 1947 <br />rn <br />M <br />505 -64 -1106 H <br />CL <br />❑ ER Outpatient ® Residence <br />° <br />D <br />� ❑ <br />p �l <br />C:D <br />rn <br />Grand Island Y <br />-it <br />Hall <br />v1 <br />200408712 <br />L1 <br />v <br />n co <br />3 Dg.7E OF DE 7H /Month Day. ✓earl <br />r0Una <br />David Max Rauert M <br />Male M <br />March 27, 2002 <br />C:> <br />CD <br />UNDER 1 YEAR U <br />UNDER 1 DAY 6 <br />6. DATE OF BIRTH /Month. Day. ✓earl <br />MOS. <br />%I` <br />Grand Island, Nebraska i <br />(Yrsl 54 Sb. M <br />August 17, 1947 <br />rn <br />M <br />505 -64 -1106 H <br />CL <br />❑ ER Outpatient ® Residence <br />° <br />D <br />� ❑ <br />p �l <br />C:D <br />Cn <br />Grand Island Y <br />-it <br />Hall <br />9�RESIDENCE E 9 <br />9b COUNTY 9 <br />9c CI7V. TOWN OR LOC ATION 9 <br />9d. STREET AND NUMBER llnUudng Lp 9 <br />9e INSIDE CITY LIMITS <br />H <br />s rT1 <br />Grand Island 2 <br />N <br />-13 <br />D <br />C::) <br />.tee <br />3 <br />r � <br />(Specyl N <br />NEVER DIVORCED <br />Ruth Poppe <br />r n <br />cn <br />co <br />MARRI R <br />14a USUAL OCCUPATION tGiye kirlduf work done dunrrg most 141, K <br />--J <br />CD <br />(Specify only highest grade completed) <br />Elementary or Secondary (D -121 College 11 -4 or 5-i <br />of working file. even d retrmd) E <br />Livestock Feed 5 <br />Cil <br />MOTHER FIRST MIDDLE MAIDEN SURNAME <br />1 1 <br />Irene Schnase <br />w <br />19a. INFORMANT - NAME <br />N <br />Z <br />19b. INFORMANT MAILING ADDRESS (STREET OR R.F D. NO.. CITY OR TOWN. STATE. ZIP) <br />6775 bb oad Grand Island, Nebraska 68803 <br />SIGNA- E& 1 O. 2 <br />e <br />WFEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES <br />SYSTEM, IT CERT/FES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RE60-ki ON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAMWg WCUOK-WRICH IS <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />DATE OF ISSUANCE X�JI <br />PR �� kS�BTANT STATE RE - MAR <br />LIANCOLN, N8 EBRASKA HEALTH AN6 HC MIAN SERF SYSTEM <br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND HUMAI+ WV jM-Y sXNC=E =AND SUPPORT <br />VITAL STATISTICS - 0 2 03886 <br />r1DDTFVTrATV nF nPATU <br />I DECEDENT -NAME FIRST MIDDLE LAST 2 <br />2 SEX 3 <br />3 Dg.7E OF DE 7H /Month Day. ✓earl <br />r0Una <br />David Max Rauert M <br />Male M <br />March 27, 2002 <br />4. CITY AND STATE OF BIRTH ll /rot in USA.. name country/ 5 <br />5a. AGE - Last Birthday U <br />UNDER 1 YEAR U <br />UNDER 1 DAY 6 <br />6. DATE OF BIRTH /Month. Day. ✓earl <br />MOS. <br />Sc. HOURS' MINS A <br />Grand Island, Nebraska i <br />(Yrsl 54 Sb. M <br />August 17, 1947 <br />7. SOCIAL SECURTIY NUMBER 8 <br />8a PLACE OF DEATH <br />505 -64 -1106 H <br />HOSPITAL ❑ <br />❑ ER Outpatient ® Residence <br />8b. FACILITY - Name (d not mstitulion, give street and number) ❑ <br />2.16--.E. 2nd Street #3 ❑ <br />� ❑ <br />8c. CITY TOWN OR LOCATION OF DEATH 8 <br />8d. INSIDE CITY LIMITS B <br />Be. COUNTY OF DEATH <br />Grand Island Y <br />Yes ® No ❑ H <br />Hall <br />9�RESIDENCE E 9 <br />9b COUNTY 9 <br />9c CI7V. TOWN OR LOC ATION 9 <br />9d. STREET AND NUMBER llnUudng Lp 9 <br />9e INSIDE CITY LIMITS <br />H <br />Hall G <br />Grand Island 2 <br />216 E. 2nd Street X63 Y <br />Yes ® No 1 <br />1Black. American Indian. 1 <br />11. ANCESTRY (e g. Italian. Mexican. German, elcl 1 <br />12. MARRIED ❑ WIDOWED 1 <br />1 13 NAME OF SPOUSE (If wrte. 91W maiden name) <br />etc .)(Specify) ( <br />(Specyl N <br />NEVER DIVORCED <br />Ruth Poppe <br />White A <br />MARRI R <br />14a USUAL OCCUPATION tGiye kirlduf work done dunrrg most 141, K <br />KIND OF BUSINESS INDUSTRY 1 <br />15. EDUCATION ( <br />(Specify only highest grade completed) <br />Elementary or Secondary (D -121 College 11 -4 or 5-i <br />of working file. even d retrmd) E <br />Livestock Feed 5 <br />16. FATHER -NAME FIRST MIDDLE LAST 1 <br />MOTHER FIRST MIDDLE MAIDEN SURNAME <br />1 1 <br />Irene Schnase <br />18. WAS DECEASED EVER IN U.S. ARMED FORCES? 1 <br />19a. INFORMANT - NAME <br />(Yes. no or unk.) Itl yes. give war and dates of services) <br />No -- - - - - -- R <br />Ruth Rauert <br />19b. INFORMANT MAILING ADDRESS (STREET OR R.F D. NO.. CITY OR TOWN. STATE. ZIP) <br />6775 bb oad Grand Island, Nebraska 68803 <br />SIGNA- E& 1 O. 2 <br />21 a. METHOD OF DISPOSITION 2 <br />21b. DATE 2tc. C <br />CEMETERY OR CREMATORY NAME <br />> © <br />© Burial 1:1 Removal M <br />Mar. 30, 2002 G <br />Grand Island City Cemetery <br />22a. FUNERAL H - NAME 2 <br />21d. CEMETERY OR CREMATORY LOCATION CITY OR TOWN STATE <br />