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<br />Lot Three (3), Block Four (4) in Country Club Subdivision being a
<br />part of the East Half of the Northwest Quarter (E 1/2 NW 1/4) of h
<br />Section Twenty -eight (28), in Twonship Eleven (11) North, RAnge�`,.
<br />Nine (9) West of the 6th P.M., in the City of Grand Island, ;.
<br />Hall County, Nebraska.
<br />WHEN THIS COPYCARRFES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, !T CERTIFIES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORQ.ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECS_ *__YH_ ICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />Alt
<br />~'
<br />EY S. C *PEER
<br />JUN 13 2005 200505399 kBSISTANT ST kEGlS705"%R
<br />LINCOLN, NEBRASKA HEALTH AND HUMANSER SYSTEM
<br />xT/A�S d1i� f �M �l OM f,'l1i 11�.MN1MA�r �6tH1�E}'1IL,t� ++fl��'IQItT. - --
<br />VeYAL STJ►i1N;=
<br />CHRIVICA TR OF fg"TVF6 03838
<br />1 __ - ___ _ _ ;-- ---- --
<br />70-
<br />F CA m AW11N: py Hen►
<br />Josephine Frances Wetzel
<br />M
<br />M
<br />n
<br />1'4. CITY AM PAM OF�N �eepoiT�v�A wwwcdAKrb 10
<br />T VW
<br />1 r
<br />R DMA ONTH M a aye, vow
<br />Grand Island, Nebraska '°'
<br />January 6, 1923
<br />°'"�`
<br />Ha,AE M6uffi�
<br />503 -22 -7615 ±?!!V ❑ oT►1�� ❑ NerwlgHmrle
<br />-NNAe AleerwwYatlrL,)rMeAwwYrwnrr✓1rgl ❑ in0Aaren ® Reed.nco
<br />2223 S. August ❑ Dne ❑ DPwWaayw
<br />0" MAN OR ft UWT: 4E COUNTV 00 0U6?H
<br />Grand island ❑ Wall
<br />asum-WAS
<br />ft CITY VOW 011
<br />W S"W AND Nri"ZO CaM
<br />92 *am CITYLUM
<br />Nebraska
<br />Hall
<br />Grand Island 12223
<br />S. August 68801
<br />Y" ® ft []
<br />so RAM •MA.m",BIe[h. etlrrl
<br />7WENW069 ..M11a1LMnecRommWw, f �MAWI[9p �WIDDIFIED
<br />/3 NNAl1OFSPOu% AYR* 0"^% ff$W P
<br />c, U
<br />American 1 DNORCED
<br />Charles Wetzel
<br />Ir
<br />• ti EDUCATION
<br />11/N011r1, rIrA PAIMM
<br />l�oeeeeaker
<br />f1
<br />C►
<br />1 thh-"�a�`e
<br />10A .NAME PYABT MIDDLE WT 17
<br />mow'
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<br />Josephine Furniss
<br />N
<br />.a1rIA! nY•A�r•+wptltl.N►arYelYleTN
<br />"Chuck"
<br />NO Charles Wetzel
<br />I
<br />2223 e u st, Grand Island Nebraska 68801
<br />20 - SI<a11A i
<br />214 METIgDpFggp
<br />?1b DATE 21C
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<br />220. HOW 1 THE OR - - • •••�
<br />601 N. Webb Rogd, gjAAd.Island,_."hV0WVn 6 0
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<br />PART
<br />N IF FEMALE WAS THERE A 2a
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<br />PREGNANCY
<br />IN THE PAST 3 NOMi'1IN
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<br />2Eb DATE OF ftAMY 1W Dry. tY.F
<br />26r HDUN OF QUAY
<br />HOW RUURY MMD
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<br />❑ Sulelde ❑ Prntleg
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<br />26e INJURY AT WORK
<br />. Wm, s" Iwwy
<br />211 PLACE qF pMLURY -me"
<br />e14e6 uwNln4.lf .SUl�C�11'!
<br />26p. I,DeATgN STREET OR R.F-D. NO. CITY OR TOWN STATE
<br />❑ �
<br />YM ❑ NO ❑
<br />r
<br />2711 DATE OF DEATH /AID Dry Vr.)
<br />M DATE SIGNED IAb DAY Vr 1
<br />"b THE OP DEATH
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<br />Wc. PRONOUNCED DEAD IATO Day. YT l
<br />=PRONOUNCED DEAD /Mw)
<br />19
<br />A' April 2, 3
<br />1 6:15 am M
<br />}
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<br />CONSIDERED'+ 30.6
<br />WA5 CONSENT ORANTED7
<br />�. ❑ TES V_7 ❑ UNKNOWN ❑ YES �
<br />NO
<br />❑�'Np
<br />31 NAME AND M RTWIER IPNY91pAN. CORONER S PHYSICIAN OR COUNTY' ATTgENEYF7 lTylq�p y
<br />�Dr. John A Wa oner MO 800 Alpha Gr n ind,NE 66803
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<br />Lot Three (3), Block Four (4) in Country Club Subdivision being a
<br />part of the East Half of the Northwest Quarter (E 1/2 NW 1/4) of h
<br />Section Twenty -eight (28), in Twonship Eleven (11) North, RAnge�`,.
<br />Nine (9) West of the 6th P.M., in the City of Grand Island, ;.
<br />Hall County, Nebraska.
<br />WHEN THIS COPYCARRFES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, !T CERTIFIES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORQ.ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECS_ *__YH_ ICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />Alt
<br />~'
<br />EY S. C *PEER
<br />JUN 13 2005 200505399 kBSISTANT ST kEGlS705"%R
<br />LINCOLN, NEBRASKA HEALTH AND HUMANSER SYSTEM
<br />xT/A�S d1i� f �M �l OM f,'l1i 11�.MN1MA�r �6tH1�E}'1IL,t� ++fl��'IQItT. - --
<br />VeYAL STJ►i1N;=
<br />CHRIVICA TR OF fg"TVF6 03838
<br />1 __ - ___ _ _ ;-- ---- --
<br />70-
<br />F CA m AW11N: py Hen►
<br />Josephine Frances Wetzel
<br />Female
<br />April 2, 2003
<br />1'4. CITY AM PAM OF�N �eepoiT�v�A wwwcdAKrb 10
<br />T VW
<br />1 r
<br />R DMA ONTH M a aye, vow
<br />Grand Island, Nebraska '°'
<br />January 6, 1923
<br />°'"�`
<br />Ha,AE M6uffi�
<br />503 -22 -7615 ±?!!V ❑ oT►1�� ❑ NerwlgHmrle
<br />-NNAe AleerwwYatlrL,)rMeAwwYrwnrr✓1rgl ❑ in0Aaren ® Reed.nco
<br />2223 S. August ❑ Dne ❑ DPwWaayw
<br />0" MAN OR ft UWT: 4E COUNTV 00 0U6?H
<br />Grand island ❑ Wall
<br />asum-WAS
<br />ft CITY VOW 011
<br />W S"W AND Nri"ZO CaM
<br />92 *am CITYLUM
<br />Nebraska
<br />Hall
<br />Grand Island 12223
<br />S. August 68801
<br />Y" ® ft []
<br />so RAM •MA.m",BIe[h. etlrrl
<br />7WENW069 ..M11a1LMnecRommWw, f �MAWI[9p �WIDDIFIED
<br />/3 NNAl1OFSPOu% AYR* 0"^% ff$W P
<br />�j1'°' Whites
<br />American 1 DNORCED
<br />Charles Wetzel
<br />TAt
<br />• ti EDUCATION
<br />11/N011r1, rIrA PAIMM
<br />l�oeeeeaker
<br />y 21 cow 04&5 +1
<br />10.1
<br />Domestic
<br />1 thh-"�a�`e
<br />10A .NAME PYABT MIDDLE WT 17
<br />NIOT PST MDDLE MAMNSURNAME
<br />John "Jack" Owens
<br />Josephine Furniss
<br />u WAS IN u T 1% "ORMAK • NAME
<br />.a1rIA! nY•A�r•+wptltl.N►arYelYleTN
<br />"Chuck"
<br />NO Charles Wetzel
<br />lob rffqQWAWT M.VUNGACdRESS ( STREETORRiDND ,CITYORTomSTATE.Zon
<br />2223 e u st, Grand Island Nebraska 68801
<br />20 - SI<a11A i
<br />214 METIgDpFggp
<br />?1b DATE 21C
<br />G MfWC)SCREMATORY. NAME
<br />w�
<br />3— 0m
<br />Apr. 5 2003
<br />tWestlawn Hemorial Park
<br />22e F
<br />21d GE ORCREMATORYL A7K11/ 01YORTOWN STATE
<br />n ston -Son n F.H.
<br />❑ ° °p"L
<br />Grand Island, Nebraska
<br />220. HOW 1 THE OR - - • •••�
<br />601 N. Webb Rogd, gjAAd.Island,_."hV0WVn 6 0
<br />CAUSE TENTER ONLY ONE CAUSE PDR • +I IDIAND(C11 I MMrvwbaletlerl nleel lrtl pAMh
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<br />DUE iO.OR ASACCteI NC2 Ci '°'"�__� —� _ _ •�• Mrervrl b11Mn1 P/rM Intl tlewh
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<br />1st �
<br />,
<br />CONORIQNS • CAnA1ee11f cerrbuAlp b rls dwh butnpl g4NA PART
<br />PART
<br />N IF FEMALE WAS THERE A 2a
<br />AUTOPSY
<br />21A WAS CASE REFERRED) TO MEDICAL
<br />PREGNANCY
<br />IN THE PAST 3 NOMi'1IN
<br />E7IAMrIEROR
<br />IAgea
<br />10.5,1 Yp M Nn
<br />T.n No
<br />Yp
<br />2"
<br />2Eb DATE OF ftAMY 1W Dry. tY.F
<br />26r HDUN OF QUAY
<br />HOW RUURY MMD
<br />❑ AC an ❑ unw" l40
<br />12N.DESCAM
<br />❑ Sulelde ❑ Prntleg
<br />M
<br />26e INJURY AT WORK
<br />. Wm, s" Iwwy
<br />211 PLACE qF pMLURY -me"
<br />e14e6 uwNln4.lf .SUl�C�11'!
<br />26p. I,DeATgN STREET OR R.F-D. NO. CITY OR TOWN STATE
<br />❑ �
<br />YM ❑ NO ❑
<br />2711 DATE OF DEATH /AID Dry Vr.)
<br />M DATE SIGNED IAb DAY Vr 1
<br />"b THE OP DEATH
<br />k A pril 2.2003
<br />i
<br />1�
<br />118i
<br />M
<br />M. PATE SIGNED (Ub. Dry nr
<br />27e TARE OF DEATH
<br />Wc. PRONOUNCED DEAD IATO Day. YT l
<br />=PRONOUNCED DEAD /Mw)
<br />19
<br />A' April 2, 3
<br />1 6:15 am M
<br />}
<br />"
<br />M
<br />27tl. YPthe heYd dent ecrunnenAIr .Awe antl. Awe µeCArM Aue ivaAD tluewIM
<br />al arw 4d
<br />Z% On tlM Dam d exrmnow and of 000000. in my WW accurma
<br />4
<br />Rs tlW e am p41te en0 due b Rle eeue.iel nwetl.
<br />120moiallt
<br />8 DD O DEATH? 3Da HAS OT1prW OR TISSUE DONATION BE
<br />CONSIDERED'+ 30.6
<br />WA5 CONSENT ORANTED7
<br />�. ❑ TES V_7 ❑ UNKNOWN ❑ YES �
<br />NO
<br />❑�'Np
<br />31 NAME AND M RTWIER IPNY91pAN. CORONER S PHYSICIAN OR COUNTY' ATTgENEYF7 lTylq�p y
<br />�Dr. John A Wa oner MO 800 Alpha Gr n ind,NE 66803
<br />MnwrPT ... 4 203
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