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<br />3. GATE OF DEATH /MGM Dal, YOW
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<br />Todd Vern Allen Wink
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<br />Feb 11 2003
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<br />October 10 1965
<br />7 SOCIAL SECURTIY NUMBER
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<br />-76 -2953
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<br />16 FATHER •NAME FRST MIDDLE ST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME
<br />Charles Wink qnnfira
<br />• t6 WAS DECEASED EVER N U.S. ARMED FORGES? 196 NFORMANT•NAME .
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<br />28c PRONOUNCED DEAD lAb Day. Yrl 2
<br />20 EMBALMER - TUBE 6 LICENSE NO 21a METHOOOF DISPOS a 210. TE 21c CEMETERY OR CREMATORY NAME
<br />27b DATE BKi 41 Y ` 2
<br />Febr. 15 2003 Grand Island Cemetery
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<br />Apfel- Butler -Gedde ❑`` O— Grand Island Nebraska
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<br />22D FUNERAL HOMIE ADDRESS (STREET OR RF.D. NO. Cm OR TOWN. STATE, ZIP)
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<br />1123 West Second Grand Island, NE 68801
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<br />t DECEDENT .. NAW flow .. MIDDM,E LAST -,
<br />2 SEX
<br />3. GATE OF DEATH /MGM Dal, YOW
<br />4 -. R /
<br />Todd Vern Allen Wink
<br />Male
<br />Feb 11 2003
<br />CRY AND STATE OF BIRTH IffillOP USA. nrmmwINT1
<br />56 AGE • L0 60Vw"
<br />UNDER t DAY
<br />6. DATE CM: BIRTN (Mary,. Dal, Yow
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<br />Lincoln, Nebraska
<br />37
<br />October 10 1965
<br />7 SOCIAL SECURTIY NUMBER
<br />1P.mla OTHER ❑ N1Aw19 Hbmm
<br />% PL506
<br />-76 -2953
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<br />9• RESATE 90 COUNTY 9a: CITY. TOWN OR LOCATION 9d STREET ANO NUMBER /MtAdaq Zp Cpde1 9e INSIDE CITY UNITS
<br />ska Hall Grand Island 1904 She Blvd. 68803' Y« "°El
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<br />t0 RACa. Blac. Ammrnan Y1tl1Y1 i l. ANCESTRY le -9 IMLan. Mexican. Gwman. sal 12. O MARRIED O WIDOWED 13 NAME OF SPOUSE IAwas Arve nul0an monml
<br />wcl pjl IStlwAYI NEVER DIVORCED Bettv MatOCk
<br />1H USUAL OCCUPATION IGwm And d ww* coN OwM anal lab KIND OF BUSMIESS INDUSTRY 15 EDUCATION ISDmC-N ally n�W1me a0e Coff~l
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<br />16 FATHER •NAME FRST MIDDLE ST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME
<br />Charles Wink qnnfira
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<br />20 EMBALMER - TUBE 6 LICENSE NO 21a METHOOOF DISPOS a 210. TE 21c CEMETERY OR CREMATORY NAME
<br />27b DATE BKi 41 Y ` 2
<br />Febr. 15 2003 Grand Island Cemetery
<br />22a. FU HOME •NAME - 21tl CEMETERY OR CREMATORY LOCATION CITY OR TOWN STATE
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<br />Apfel- Butler -Gedde ❑`` O— Grand Island Nebraska
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<br />22D FUNERAL HOMIE ADDRESS (STREET OR RF.D. NO. Cm OR TOWN. STATE, ZIP)
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<br />1123 West Second Grand Island, NE 68801
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<br />28q TIME OF DEATH
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<br />This ceriifict"t'his ~wdocument to be a true copy of an original record on file with Vital
<br />statistics, Douglas County Health Department, Omaha. Nebraska. Certified copies must have
<br />a raised seal in the area to the left. Reproductions of this green certificate are not
<br />legal copies.
<br />Date issued: FES 2 S M03 Registrar: As C%
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