Laserfiche WebLink
ref ca cr> <br />an rn _ C.XN ca - CZ) <br />�.�..� C f"1 _ c n <br />rrwwArrrNBMwrlee C1 Z z + <br />rri <br />C) <br />N ■.rem (7 t=rnl a <br />CA <br />n > =n C-, '► <br />, <br />� Imo, C <br />FTI CD C-11 rte- c <br />W r.r.rN..rrar <br />CD <br />Cn w u <br />aarl6a..NIMN� ��-{ <br />r� <br />� x <br />a <br />-r <br />[. Y <br />[� rAi rr <br />v 1,J <br />a <br />t • C:) <br />:! <br />f <br />< C, <br />A <br />ry <br />C) G� <br />F' J •'7 <br />:xs <br />I-� M <br />H� <br />r <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES <br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTIO& WHICH IS <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. <br />DATE OF ISSUANCE - == <br />APR 2 7 ZQ05" - AHLEYS. COOPED_ <br />LINCOLN, NEBRASKA 200504073 HEALTH AND HUMAN SERVICES SYS�M <br />STATS OP NEIRAWA DEPARTMENTSF HEALTH Aran HUMAN SMVKM M4ANM ANe) <br />VITAL STA73iM <br />CER'TIFICA'TE OF DEATH n q .1 _� .� 11 <br />�. pi7.EDlWY -NAME FMI MIME LAST <br />2 SEX <br />3 ?R MATH <br />Dix NlSN Watson <br />Male <br />September 23, 2002 <br />F..7rY ATaD AlE QF BMiTi1 AF1W#; US A A8M6*I0 [aV) <br />S,. ACE - LW 044* 1 <br />UNDER 1 YEAR <br />UNDER t PAY 14. DATE OF BIRTh1 <br />k MOS DA <br />_ ..... <br />Wood Riser, Nebraska <br />NMI <br />67 <br />Sc. woft Wks <br />i Jam><aEy 5, 1935,_ <br />- <br />]. SOCIAL SN.E -err N wRot <br />...__. <br />6M PL.AGE OF DEATH <br />506 -38 -7045 <br />Tx ❑ 100111110111 OnrR ❑ I&=- .�. <br />® ER OWI00Iara ❑ A"a"A <br />BO FACAI7Y—Nare !►rM4 <br />St. Francis Medical Center <br />❑ DOA ❑ o.>,erAs11100410 <br />Se Crry Tr' w 0Dli LM T'd?N Oi 5EATi+ - w Nam vin L11111TS as cOLWTV [Y.= DEATH <br />Grand Island n6 ❑ . hall <br />i RES1pENCfr. - S-[AT£ COWiNFTY <br />s c. CITY. TOWN OR LOCATION Od. STREET AM NNMIBER lrraargiio Cnarr. ar avBr1E wTs <br />Nebraska I Hall <br />Grand Island 2409 N. Custer 68803 Tr. 0 [; <br />10. RAGE • W SL VRaR BNAc%. ArmKr1 M+drN1r 11 ANCESTRY is 9.. MILL. Macd:6n. Or17M MCI 12. ® MAR(VED ❑ WIDOWED NAME OF SKWN C/ wlr. gYeArltlrn wrWY/ <br />113 <br />�i ""'White American Delores J. Allen <br />i NEVER DIVORCER <br />14A L1S1,A:00CUPATION tr-w Aodcw`W %4100MYa><1,dkMr <br />1 40 KNO Of BUSINESS INDUSTRY <br />T5. EC ATM iSwIlVOr1IF C -01100 <br />E rimwo" to .121 3 ,• s > . <br />""IRM ec . S. Army <br />Military <br />td FAn1E.R -N0a PMT ►Al1LM.E LAST 17 MOTHER FMIST MIDDLE MIUMN$UANiA1ME <br />Elmer Watson Alice Cox <br />1 <br />16 WAS DECEASED EVER W U5. ~I' FONCES <br />1Be INFORMANT • NAME <br />Ives M. w ork van. 9ws w and drag d as wow <br />Yes: /25%1954 8/3i ±1976 <br />Delores J. Watson <br />196. WFORMAW WfLMM ADDRESS f5TREET OR R.V D NO.. CITY OR TOWN ST ATE. ZM <br />2409 N. Couster, Grand Island, NE. 68803 <br />20 . EMB&LMER - &SNAT RE R LICENSE NO <br />21a METHOOOF DGPOSITgN 2t0. DATE 121C CEMETERY OR CREMATORY NAME <br />®B�r ❑R Sept. 26, 200t Ft. McPherson National <br />2"(1 CEMETERY OR CREMATORY LOCATION CiTYORTQWN STATE <br />224 FUNERAL HOW -NAME <br />Apfel- Butler- Geddes <br />El ❑OW49W 1 MAxwell, Nebraska <br />Y <br />220 FUNERAL HOME ADDRESS !STREET OR R F.D NO.. CITY OR TOWN. STATE. i1JPr <br />1123 West Second, Grand Island, NE. 68801 <br />23. VAME&ATE CAUSE , !ENT Y ONE CAUSE PER LINE F 1 tbf AND ICII :r1W, v+l OaWwafN4orKar aw <br />PART <br />1 <br />ar C.•: <br />DUE TO. A COHSE OF MWval6alw„q onm ow dfar <br />WAS <br />Wt- TO. Qn� A$ A f$EOUemre . We..N 711ararrl our and dra. . <br />u <br />Ki , D <br />StGNIFIC" COND1TIOks Cmfta cOr*u "1S v1e daFar t a ha PART IH P FEWLE WAS THERE A 24 AUTOPSY 25 WAi CASE REFEWiD TO MEOM.A, <br />PAR7OTHER <br />%NANL'Y IN THE PAST 3 MONTHS EMAMNER OR C <br />V t •• - V i d1s IAges f0 -511 V46 No Yea Vn F] ORON <br />-T- <br />9% I2tl5 DATE (IfAIJURV i4o CYr Vr.1 26c WOUROFItURY 26d DESCRIBE HOW%A)RY OCCURRED <br />M_yvdary [3 iY1dFIRr-,.s i I M <br />Sur -'W [3 Fe.*19 260 K101T,'AY !6r PLACE QFy-+ W� WW fKgry 269 LOCATION STREET OR R F NO C,ITV OR TOW% STATE -- <br />IAtFMre <br />1.YFl19d•Or, i YML ❑ NO ❑ 1 a�etK.anB 3aFC�/h <br />1 <br />'pDmod. <br />^^ <br />-7. 7ATE OF OCATN (W D&V Yr1 <br />26. DATE $MANED 1W D., VI! TAME OF pEATr. <br />I September 23, 2002 <br />E <br />M <br />1.1E 1 2TU� VASE SASHED 'w DNY Y- 1 1 Ylc TIME OF DEATH f <br />26e PROWXOXED DEAD A* rVy. YO 28d PRDNOi N FD DEAD pbwr <br />9/24/02 7:4$ AM M <br />il 27d <br />M <br />On 7f1e fa d.k�-Va and p - VO669000-. n my LW deck MCWW i <br />SMw - - <br />Ind m Mrs arld pl,ca &vJ due a VW c*VWSi fLMW. <br />�CawW.A, <br />i. As and T�` <br />.-' ....fi..�s'yrl�ruro <br />29 DID TOBACCO UgF CONTRWBUT-E TO THE DEATH" 30a HAS OR TI$SUE DONATION BEEN <br />�iYEE 11 NO ❑ WAOM E] YEi S � <br />CON$pERED1 306 W ^.v q.!iSFNT GRANTEDI <br />NO ❑ 4E$ ❑ NO <br />_ <br />�_ <br />rrn!J <br />1 MME AADApRESS OF CERTFIER IPHSCIAN, C[ MP S PHYSXMN OF COUNTV ATTORNEVi p <br />William J. Landis M.D. 2444 W F idler Ave., Grand Island NE. 68803 <br />F _ <br />—� <br />32a REWTRAR� 320 IIA.TE FO ED BY RFCOSTRAR AID Aar YN <br />� tit, ! SEP 3 0 2002 <br />V - <br />