|
Rev. 1 1 STATE OF NEBRASKA- DEFARTKffiTf OF HEAETHAND HUMAN SERVICES nNMIE T
<br />VRAL STATISTICS '261 0 2 3 8 2
<br />CERTIFICATE OF DEATH
<br />AS
<br />AD
<br />'o
<br />E
<br />F a
<br />zE
<br />vH
<br />w
<br />o A
<br />w —
<br />W a
<br />on
<br />w ,dN
<br />zLL
<br />M
<br />FOR VITAL STATISTICS USE ONLY
<br />NSC
<br />RINGS ...I way LA. ". pe-
<br />.. ............._.... ........... part [I --- ...............TMV
<br />Tract NC
<br />I HEREBY CERTIFY THAT THIS IS AN EXACT PHOTO -COPY OF THE ORIGINAL DEATH CERTIFICATE
<br />FILED WITH THE BUREAU OF VITAL STATISTICS IN LINCOLN, NEBRASKA.
<br />FPOMpNDO NDO2� 20 ^ APFEL— BUTLER— GEDDES PURER
<br />MY God' E
<br />ECEDENr.xAME GANII MIDDLE ufir
<br />z aEx
<br />]. oniF —AeiX (Mwehw,. vavl
<br />Basil Ira Brawn
<br />19a1e
<br />Februa 16 2001
<br />.. GYANDPLI Bill" (om- renm
<br />E a I
<br />LINO
<br />. 01a IMmT.ON ✓ul
<br />Foil, Missou
<br />MD
<br />Decernber 6 1920
<br />DclAL 6ECVPT1Y xuMBEP
<br />PA FvE.IH
<br />469 -26 -1811
<br />— HOSPIRPIL ❑ " "ePN — " "elaB N010e
<br />❑ EH OUlpeuem ❑ x,,.,,,
<br />mCIM *V -Mama I "'. fiNMn pRr.uwnoa"•mwa
<br />•
<br />Grand Island Veterans Horne
<br />❑ "0A ❑ °°'°'(SII
<br />ecC TiowN OR WCATIOI DF 041H
<br />EJ. INSID E Em EMITS
<br />.carvIV OE DEATH
<br />Grand Island
<br />Y °a ® NO ❑
<br />Hall Count
<br />E, RESIDexcE.srnre
<br />sa cvuury
<br />aA Clrr. rowx DP LDCnnoN
<br />se. srPEEl ANO rvvmazB Imm,e.yza cmel
<br />wsloEar Y UMlrs
<br />Nebraska
<br />Ball
<br />Grand Island
<br />510 S1- Charles St. 6880
<br />-A ❑X Na ❑
<br />9e44 -1a9, wnnA ®xe Amn¢.neeMn AxcEEiFr I. p.. n.IIUI,Mp¢am G.rma", eCl IE Vr}Mn ANN ❑wIDOwEE nnmEOF SPOUSE M.•N. grwmSan wmal
<br />D,Ii+ilir
<br />PC5
<br />.e I6P.eIroL I"sh/En lish Cfl "EVEP Li nora Harms ED
<br />a FOUCAiION ISPx•Nm' 11. greens
<br />(U•vevMNVe6fn M+9mml P xINOOF BU9NE391N°USiPV
<br />ENAuel
<br />NA ewnJmwMl T ,,etc D 1VCY, Ek rExoMUY 1PRl Cdlga 1, -<w YI
<br />-�J7ne
<br />ce statio�i TransportonI
<br />rIBAS�UAL�EAJIAGGN
<br />INME xFST MIDGLE usT
<br />n. MOrXEP FIPST MIDOLE MAEUNAME
<br />John Brawn
<br />Oma Victoria R
<br />FASE0 WET M TS FPMED FORESID
<br />wF°PMANT, NAME
<br />IIII nlr�vNa -a a�ml.a n..x�./
<br />Yes, 06 01 -1942 to 04 -20 -1946
<br />Linora Brown
<br />E e. INFOPMART MAILINGADOXESS IITICETOP P F G. For. BIT GP IOWx Si ALA, EI11
<br />5 0 W. /Charles St Grand Island, NE. 68801
<br />I
<br />31 a. MEII1LOOf DISPo911gN
<br />e. WTE 41
<br />EFeb.
<br />e. CEMETEnv On ENFMATGPY -NAME
<br />;vN "
<br />®EmIM ❑R. "WRM
<br />20, 2001
<br />Rol Cemetery
<br />xn
<br />GEMERMYCAGPEMATORY LOCATION CTI OR TOWN STATE
<br />AFu pNE� - Butler- Geddes
<br />❑ "m"" ❑� "'
<br />Shenandoah Iowa
<br />CE ISLFEETORNFD NO cn MTGW". ATATEn%
<br />1123 West Second, Grand Island, NE. 68801 _
<br />11 EDIRECAUBE IENTERONLVONEPU5eve0MNEFOPm1. FITAND ld1 1 lnwal eanvwn ovelam eealn
<br />PANPH Cardiopulm ary Failure 1 Hour
<br />DDErD, ORASAmx11°u6xcEGF 1 HIMPSl uNMRaNR.Mal III J Al
<br />Pnemonia 48 Fours
<br />IIT
<br />DUET07A PACEDGE0UExCt V- Immel Mmae RY—ii le,
<br />IF)
<br />I?5.
<br />O NFCANTOOxOCON6- GUaNmIENNibNryNlM1e JHAD NI IM AID
<br />H
<br />MALE WAS PUiOPBY
<br />SAS PSE PEFEPPED TO
<br />MEDIUL
<br />PANT
<br />Coronary Heart Disease, Parkinson Ts
<br />PR
<br />FA
<br />M G6c°mNER?
<br />Disease Renal cancer.
<br />IAPea,PY.IN Yve
<br />°A¢°FIWURY (W.Oay,Bj
<br />_HWROFN,URV DEBUTIRL"WRALT C6UPPE°Vf5
<br />oRamoMax,
<br />❑ s..... , ❑ P eMR
<br />4E.. INJ RN
<br />y6LO ieryE, L;HRY .Iam,. aMl.eI.MWMy
<br />LOCATION ALBION x FD.,o- YEA... srare
<br />- DATE OF DEATH (m CIA Y.J
<br />�Februaiy
<br />Ex. .DATE EIGNED (M.O,y .,I
<br />rIME°F 111
<br />16, 2001
<br />-
<br />_
<br />—
<br />AN Dnre GRANCE nm. HAL Ill
<br />TwE OF °uTX
<br />xc. PRONOUNCED DEAD (.Me. CIA Y,l
<br />aNONDUxcfio °EnD rrlawl
<br />yy e
<br />February 16, 2001
<br />8:50 A. A.
<br />,¢e£E
<br />A
<br />q;
<br />11 TI Vmw me.mx gawan0 ,
<br />', NN AA a eA e
<br />Y w. .,A ED
<br />'°" "mroP�•.olla.nmaa.I�ee.I
<br />.va=lei ae�.e.
<br />Ilm..eN.. .a..emaou. ea � eI.i
<br />III /'-
<br />p M �— ` r>
<br />19 Ilv i RNa IF
<br />D WE ELBE TO THE 0EAiX?
<br />°i❑
<br />MA XA90Wµ CP ISSUE I INAlILW BEEN C°XSECARIT
<br />WABCOx6ENTGPATTED?
<br />YES NO ❑ I.Av N
<br />❑ YE6 © NO
<br />❑ YE6 J2 x°
<br />A AME AND A EP [PH YGAND COFANERA PHYSIGAN OR CWNIY A70PN EYI (ip Y nul
<br />Duane E. Baker, M.D., Grand Island Veterans Home, Grand Island, NE 68803
<br />AAA REGISTRAR __
<br />LO.O>iERtEOEV PECISTRax (,.b. GTr Y,l
<br />FOR VITAL STATISTICS USE ONLY
<br />NSC
<br />RINGS ...I way LA. ". pe-
<br />.. ............._.... ........... part [I --- ...............TMV
<br />Tract NC
<br />I HEREBY CERTIFY THAT THIS IS AN EXACT PHOTO -COPY OF THE ORIGINAL DEATH CERTIFICATE
<br />FILED WITH THE BUREAU OF VITAL STATISTICS IN LINCOLN, NEBRASKA.
<br />FPOMpNDO NDO2� 20 ^ APFEL— BUTLER— GEDDES PURER
<br />MY God' E
<br />
|