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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY `SCj
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS. - -_-
<br />DATE OF ISSUANCE -
<br />MAR, 4 IM STSIEY=.s. = COOPER;=_. DIRECTOR
<br />LINCOLN, NEBRASKA BUI -AU - -- @F'= VITAL. - - STATISTICS
<br />2005046(o Y-
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH U r
<br />1. DECEDENT • NAME FIRST MIDDLE LAST
<br />2. SEX
<br />3. DATE OF DEATH (,NOnM, Day, Year)
<br />Robert Lee Veeder
<br />Male
<br />February 15, 1993
<br />4. CITY AND STATE OF BIRTH (d riot in U.S.A, name Country)
<br />Sa- AGE - Last Birthday
<br />6. DATE OF BIRTH (Abnp), Day, Year/
<br />5b. MOS. DAYS
<br />5C. HpURSI MIHS,
<br />(Yrs.)
<br />Cairo Nebraska
<br />62
<br />May 3, 1930
<br />7. SOCIAL SECURITY NUMBER
<br />Ba. PLACE OF DEATH HOSPITAL ❑ Inpatient Q EgiOutoadem 0 DOA
<br />507 -32 -8156
<br />0-THER: © Nuning Home )0 Residence 0 Other (Spacsy1
<br />8b. FACILITY - Name in nor insftinon, give !heat and number)
<br />BC. CITY, TOWN OR LOCATION OF DEATH
<br />W. INSIDE CITY LIMITS
<br />8•, COUNTY OF DEATH
<br />(Specify Yea a No)
<br />607 S. Alexandria
<br />Cairo
<br />yes
<br />Hall
<br />Be. RESIDENCE - STATE
<br />96. COUNTY
<br />90, CITY, TOWN OR LOCATION
<br />ad. STREET AND NUMBER (InciudkV Zip Cddq
<br />9e. INSIDE CITY LIMITS
<br />(SPec,ty YM W NO)
<br />Nebraska
<br />Hall
<br />Cairo
<br />607 S. Alexandria
<br />10. RACE - (e.g., White. Black, American Indian,
<br />ANCESTRY Ie.p..haaan, Mexican, German, elc.1 12. MARRIED,NEVER MARRIED,
<br />13. NAME OF SPOUSE 10 -4, give maiden name)
<br />Me I I'Awify,
<br />Ill.
<br />(SP-4) WIDOWED, DIVORCED (Sperry)
<br />I
<br />White
<br />German Married
<br />Emo ene Rathman
<br />t4a, USUAL OCCUPATION (Give kind of work done during most
<br />14b. KIND OF BUSINESS INDUSTRY
<br />Elementary or Secondary (0 -12) Canape (t -4 w 5•)
<br />of working lire, awn if rearedl
<br />Road Maintenance
<br />Nebraska De t. of Roads
<br />12
<br />16. FATHER - NAME FIRST MIDDLE LA5T
<br />17. MOTHER - MAIDEN NAME FIRST MIDDLE LAST
<br />Earl E. Veeder
<br />Ella Whitefoot
<br />r 18. WAS DECEASED
<br />EVER IN U,S. ARMED FORCES?
<br />19. INFORMANT • NAME - MAILING ADDRESS (STREET OR R,F.O, NO., CITY OR TOWN, STATE, ZIP)
<br />(Vet, no, or unk.)
<br />(K yes, give war and dams of services)
<br />es
<br />Korean 1950 -52
<br />Emo ene Veeder, Box 421 Cairo-,, Nebraska 68824
<br />20L BURIAL, CrematidgRemoval,
<br />200. DATE
<br />20C, CEMETERY OR CREMATORY - NAME Zoo.
<br />LOCATION CITY OR TOWN STATE
<br />Donation
<br />I
<br />Burial
<br />Febr 18, 1993
<br />Mt. Pleasant Cemetery
<br />Cairo, Nebraska
<br />21. EMBALMER - _SIGNATURE d LIQENSE NO.
<br />22. FUNERAL HOME - NAME AND ADDRESS (STREET OR R.F,O, NO., CITY OR TOWN, STATE, ZIP)
<br />6
<br />A fel Funeral Home, Wood River, Nebraska 68883
<br />23, IMMEDIA USE (ENTER ONLY ONE CAUSE PER LINE FOR (a), )b), AND (C)) Interval between onset and death
<br />PART
<br />1. 1 IT i C� .. 1J 5 Y T ft etti. -&
<br />DUE TO. OR AS A CONSEQUENCE OF: I ntarval between onset and death
<br />1
<br />I
<br />DUE TO, OR AS "A CONSEQUENCE OFD b1i6FrtbelWein onset and death
<br />I
<br />I
<br />OTHER SIGNIFICANT CONDITIONS - Conditions contributing to death but not related
<br />PART III IF FEMALE, WAS THERE A
<br />24, AUTOPSY
<br />25. WAS CASE REFERRED TO MEDICAL
<br />PART
<br />PREGNANCY IN THE PAST 3 THS?
<br />(Speeiry Yes M No)
<br />EXAMINER OR CORONER?
<br />II W
<br />Vt
<br />res ❑ Nb
<br />(Specify No)
<br />26a. ACCIDENT, SUICIDE, HOMICIDE, UNDET.,
<br />126b. DATE OF INJURY theo,Day, Yr.)
<br />260. HOUR OF INJURY
<br />26d. DESCRIBE 14C W INJURY OCCURRE
<br />OR PENDING INVESTIGATION ( Speciy/
<br />268. INJURY AT WORK
<br />261. PLACE OF INJURY - At home, farm, street, Iacldry,
<br />26g. LOCATION STREET OR R.F.D. NO CITY OR TOWN STATE
<br />(Specify Yea or NO)
<br />o6KY building, etc. (Specify)
<br />iiii
<br />27s. DATE OF DEATH (MO.. Day. Yr.;
<br />28a. DATE SIGNED IMo., Day, YrJ
<br />280. TIME OF DEATH
<br />` Cl
<br />Z ` \ •
<br />B
<br />S
<br />DATE SIG ED /Ale.. Yc)
<br />27c. TIME OF DEATH
<br />28c. PRONOUNCED DEAD /Mp., Day, Yr,)
<br />280. PRONOUNCED DEAD (Hour)
<br />ly.
<br />;27d,
<br />B
<br />the be of my k teeth oCCUrr and place end due to the
<br />On me 0etre M examinetion anolar Invastigakon, in my Opinion death occurred a
<br />use(sl s
<br />is
<br />the 0me, data and oboe and duo t0 the causes) stated.
<br />Si nature end Title I
<br />5i noun anti Title
<br />29a, DID TOBACCO USE CONTRIB HE DEATH?
<br />309 . HAS OR TISSUE DONATION BEEN CONSIDERED?
<br />30b. WAS CONSENT GRANTED?
<br />0 YES 0 NO 30 UNKNOWN
<br />0 YES X NO
<br />0 YES 19 NO
<br />31. NAME AND ADDRESS OF CERTIFIER (PHYSICAN, CORONER'S PHYSICAN OR COUNTY ATTORNEY) (Type "y Print)
<br />Steve L. Husen 908 N. Howard Av. Box 9802 Grand Island, Nebr 68802
<br />32a, REGISTRAR
<br />326. DATE FILED BY REGISTRAR 'W- Day. 11
<br />FEB 2 8 199,
<br />The Northerly 41 Feet of Lot Twelve (12) and all
<br />of Lot Thirteen (13)r and the Southerly 9 feet of
<br />Lot Fourteen (14) all in Block Two (2) in the
<br />Fifth Addition to the Town of Cairo, Hall C7ounty.
<br />Nw aanka.
<br />
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