|
Legal Description: The East Half (El /2) of lots Two(2),Four(4)Six(6) Eight(8) and Ten(10) in Block
<br />Seven (7), in College Addition to West Lawn, in the City of Grand Island, Hall County, Nebraska.
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMRVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RE=W -4O i1FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTL 53ECeTlIGH /S
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. -
<br />DATE OF ISSUANCE
<br />fU, _
<br />t A
<br />_NLEY S C660M
<br />200508459 AcestarAw snAm AEGwMAR
<br />LINCOLN, NEBRASKA HEALTH ANg MMAN 391VICES $WTAN'
<br />STATE OF NEMASKA— �ARTMENT OF IMTO. = =. -'=
<br />SUREAU OF VITAL STATISTICS
<br />77 1
<br />{
<br />CERTIFICATE OF DEATH,, .,,,., r, 2849
<br />DECEDENT —NAME FIRST
<br />A /Me., Amy, Yr.)
<br />Bernice Juanita Cynkva
<br />Female
<br />November 6, 1982
<br />RACE — (e.g., k, American
<br />COGIN/DESCENT (e.g., Italian, Merkae, E —Lmw siobday UNDER t YEAR UNDER 1 DAY
<br />DATE OF BIRTH we_ oar, V,
<br />Indian, «r.) r' ate
<br />rO
<br />(Yn.J 51 Mos. DAYS HouRS MINS.
<br />Gerr.a/I. tAfner dy an
<br />X�'iCC '
<br />June 18 31
<br />9
<br />4.
<br />C� 6b. 6t.
<br />9
<br />CITY AM STATE Of BIRTH /K ttd in U.S.A., CITIZEN OF WHA C N
<br />NMI ED,
<br />NAME OF SPOUSE / , gtrr lnaidoe na•tel
<br />c"sky ind seyi Nebraska it. Usk
<br />o Dow�°IYa�Ce�rsp«iry)
<br />111. Ralph Cynova
<br />55
<br />r�J
<br />`-,
<br />C7
<br />USUAL OCCUPATION (Giro kind o/work done during mess KIND
<br />OF BUSINESS OR INDUSTRY
<br />COUNTY OF DEATH
<br />-34 -6271
<br />of working fit orou )F n.d
<br />ome=n ; � �; 113b.
<br />Home.
<br />1140, Hall
<br />1,.508
<br />I
<br />o
<br />Cz
<br />MGM CITY LIMITS
<br />HOSPITAL OR OTIM INSTITUTION -- Mar (M net in oirkor, OF
<br />NOV. Olt ""T. kadsrtr DOA,
<br />Grand Island
<br />(Spwed"r,�a or Rol
<br />ZB8
<br />gi ..d R
<br />i1ra" tis Med. Center
<br />• Myetirwt (SHr+r►
<br />npatient
<br />1
<br />t, 1M
<br />RESIDENCE — STATE
<br />COUNTY
<br />CITY, TOWN OR LOCATION
<br />STREET AND NUMBER
<br />INSIDE CITY UNITS
<br />,sae Nebraska
<br />I5b. Hall
<br />�d Island
<br />2417 W. Capital Ave.
<br />(Specify w No)
<br />'�`es
<br />,xt
<br />,3d.
<br />,�
<br />FATHER—NAME MIDDIC u
<br />HE —MAN
<br />,. Joseph Rohatsch
<br />Jessie Comstock
<br />WAS DECEASED EVER IN U.S. ARMED FORCES?
<br />INFORMANT— NAME -- RELATIONSHIP — MAILING ADDRESS IS JWJ T m 5 & W ATE, ZM1
<br />(Yes. "' NrA) ( T. 9iw ww rd "tn 5"*)
<br />1B. o
<br />,q_ Ralph Cynova, Husband, 2417 W. Capital Ave., Grand/
<br />BURIAL, Cremation, Ratner -1
<br />CEMETERY OR CREMATORY —NAME
<br />LOCATION CNTYOR TOWN STATE
<br />sea. al
<br />Nov. 9, 1982
<br />2m, Westlavn Memorial Park
<br />C. Grand Island, Ne.
<br />R E
<br />�� W
<br />FUNERAL HOME --NAME AND ADDRESS (STREET OR R.F.D. NO.. CITY OR TOWN, STATE, IV)
<br />CA
<br />22.Livingston- Sondermann's,505 W. Koenig, Grand Island,Ne
<br />DAT! TH (Mo., Dar, Yr.)
<br />Moe r. Yr.)
<br />R OF
<br />23a, 6 No 1982
<br />C
<br />s
<br />t
<br />240. 2Eb
<br />M
<br />Dar,
<br />HOUR OF DEATH
<br />. OU
<br />PRONNCED DEAD PRONOUNCED
<br />DEAD (Hour)
<br />9 November 1982
<br />r (Moe, Dar, Y.)
<br />2*.
<br />27u. 4:06 pe M
<br />24c.
<br />i V
<br />w1... dow* .send e1 tAe tlme, dtge rrd rMr..wA dw N tkr
<br />f41 %7 kMM n
<br />w d.. (,..Te el r�r�riMNrr •rdhr iwr..N�rtl.r. iw�wr .piri.r tkteM
<br />16r tiwr, deb e.d Md dw » the cerre(Q reseed.
<br />1sim re ••d V00 SIP
<br />:
<br />p1«e
<br />24e. f ft-otrn end Title) ■
<br />HAM AM X50M OF R (11" C PH IAN C N ATT (Type or Prim)
<br />W. J. Landis, M. D.F 2444 Faidley Ave., Grand Island, Nee 68801
<br />REGISTRAR
<br />DA EIVED BY REGISTRAR (Mo., Day. Yr.)
<br />CAUSE (ENTER ONLY CrE CAUSE FE" I ), (b), AND (e)) 1rNr..t rer..ew ewrr w..tM
<br />PI'RT
<br />�
<br />w)
<br />Due A it , 1„Mnwi due*
<br />r..._
<br />Cry
<br />DUN T A ENCE Of- • ; lier""e!F"e""t'"• drrd.
<br />49
<br />k1 «�1
<br />PART eewhiy.tiRe tw ae1 rehled FART
<br />B Ft1EOMANCY
<br />it
<br />IN. Nt FEMALE wA5 TN AUTOPSY
<br />IN TM� FAST S r I (SpeeNr r« « FN)
<br />Tet © No ❑ 2t. NO
<br />WAS CASE >ZI COII O IM 10 N4KA1
<br />!J(A11Mrr[R OR CORONER
<br />iprik Yes w me)
<br />29. Q
<br />ACCIDENT, SUKI MI, NOWCIDL UNNT.,
<br />DATE OF INJ ., *.r, rr.►
<br />N OF 10QURr
<br />1NISCRNE Now IWURT OCCumm
<br />OR mbdw 6 ww""OATw". (Sowdy)
<br />I
<br />j
<br />700.
<br />70b.
<br />30e. M
<br />70d.
<br />Q AT WORE
<br />(Spot* Y« w No)
<br />E 01 RUURY— M tern, Nnet, lwetery,
<br />73:7 yrildias, .tr. (Specify)
<br />LOCATION STREET OR R.F.D. Nee CITY W TOWN STATE
<br />70e.
<br />t
<br />c o
<br />�
<br />CCnn
<br />rISEI1RRRa
<br />cQ
<br />o
<br />�'
<br />u
<br />cry
<br />,�
<br />,
<br />.�
<br />..RRE>r...
<br />�---
<br />o
<br />Legal Description: The East Half (El /2) of lots Two(2),Four(4)Six(6) Eight(8) and Ten(10) in Block
<br />Seven (7), in College Addition to West Lawn, in the City of Grand Island, Hall County, Nebraska.
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMRVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RE=W -4O i1FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTL 53ECeTlIGH /S
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. -
<br />DATE OF ISSUANCE
<br />fU, _
<br />t A
<br />_NLEY S C660M
<br />200508459 AcestarAw snAm AEGwMAR
<br />LINCOLN, NEBRASKA HEALTH ANg MMAN 391VICES $WTAN'
<br />STATE OF NEMASKA— �ARTMENT OF IMTO. = =. -'=
<br />SUREAU OF VITAL STATISTICS
<br />77 1
<br />{
<br />CERTIFICATE OF DEATH,, .,,,., r, 2849
<br />DECEDENT —NAME FIRST
<br />A /Me., Amy, Yr.)
<br />Bernice Juanita Cynkva
<br />Female
<br />November 6, 1982
<br />RACE — (e.g., k, American
<br />COGIN/DESCENT (e.g., Italian, Merkae, E —Lmw siobday UNDER t YEAR UNDER 1 DAY
<br />DATE OF BIRTH we_ oar, V,
<br />Indian, «r.) r' ate
<br />rO
<br />(Yn.J 51 Mos. DAYS HouRS MINS.
<br />Gerr.a/I. tAfner dy an
<br />X�'iCC '
<br />June 18 31
<br />9
<br />4.
<br />C� 6b. 6t.
<br />9
<br />CITY AM STATE Of BIRTH /K ttd in U.S.A., CITIZEN OF WHA C N
<br />NMI ED,
<br />NAME OF SPOUSE / , gtrr lnaidoe na•tel
<br />c"sky ind seyi Nebraska it. Usk
<br />o Dow�°IYa�Ce�rsp«iry)
<br />111. Ralph Cynova
<br />55
<br />SOCIAL SECURITY MURDER
<br />USUAL OCCUPATION (Giro kind o/work done during mess KIND
<br />OF BUSINESS OR INDUSTRY
<br />COUNTY OF DEATH
<br />-34 -6271
<br />of working fit orou )F n.d
<br />ome=n ; � �; 113b.
<br />Home.
<br />1140, Hall
<br />1,.508
<br />I
<br />CITY. TOWN OR LOCATION OF MAIN
<br />MGM CITY LIMITS
<br />HOSPITAL OR OTIM INSTITUTION -- Mar (M net in oirkor, OF
<br />NOV. Olt ""T. kadsrtr DOA,
<br />Grand Island
<br />(Spwed"r,�a or Rol
<br />ZB8
<br />gi ..d R
<br />i1ra" tis Med. Center
<br />• Myetirwt (SHr+r►
<br />npatient
<br />1
<br />t, 1M
<br />RESIDENCE — STATE
<br />COUNTY
<br />CITY, TOWN OR LOCATION
<br />STREET AND NUMBER
<br />INSIDE CITY UNITS
<br />,sae Nebraska
<br />I5b. Hall
<br />�d Island
<br />2417 W. Capital Ave.
<br />(Specify w No)
<br />'�`es
<br />,xt
<br />,3d.
<br />,�
<br />FATHER—NAME MIDDIC u
<br />HE —MAN
<br />,. Joseph Rohatsch
<br />Jessie Comstock
<br />WAS DECEASED EVER IN U.S. ARMED FORCES?
<br />INFORMANT— NAME -- RELATIONSHIP — MAILING ADDRESS IS JWJ T m 5 & W ATE, ZM1
<br />(Yes. "' NrA) ( T. 9iw ww rd "tn 5"*)
<br />1B. o
<br />,q_ Ralph Cynova, Husband, 2417 W. Capital Ave., Grand/
<br />BURIAL, Cremation, Ratner -1
<br />CEMETERY OR CREMATORY —NAME
<br />LOCATION CNTYOR TOWN STATE
<br />sea. al
<br />Nov. 9, 1982
<br />2m, Westlavn Memorial Park
<br />C. Grand Island, Ne.
<br />R E
<br />�� W
<br />FUNERAL HOME --NAME AND ADDRESS (STREET OR R.F.D. NO.. CITY OR TOWN, STATE, IV)
<br />2 .
<br />22.Livingston- Sondermann's,505 W. Koenig, Grand Island,Ne
<br />DAT! TH (Mo., Dar, Yr.)
<br />Moe r. Yr.)
<br />R OF
<br />23a, 6 No 1982
<br />C
<br />s
<br />t
<br />240. 2Eb
<br />M
<br />Dar,
<br />HOUR OF DEATH
<br />. OU
<br />PRONNCED DEAD PRONOUNCED
<br />DEAD (Hour)
<br />9 November 1982
<br />r (Moe, Dar, Y.)
<br />2*.
<br />27u. 4:06 pe M
<br />24c.
<br />i V
<br />w1... dow* .send e1 tAe tlme, dtge rrd rMr..wA dw N tkr
<br />f41 %7 kMM n
<br />w d.. (,..Te el r�r�riMNrr •rdhr iwr..N�rtl.r. iw�wr .piri.r tkteM
<br />16r tiwr, deb e.d Md dw » the cerre(Q reseed.
<br />1sim re ••d V00 SIP
<br />:
<br />p1«e
<br />24e. f ft-otrn end Title) ■
<br />HAM AM X50M OF R (11" C PH IAN C N ATT (Type or Prim)
<br />W. J. Landis, M. D.F 2444 Faidley Ave., Grand Island, Nee 68801
<br />REGISTRAR
<br />DA EIVED BY REGISTRAR (Mo., Day. Yr.)
<br />CAUSE (ENTER ONLY CrE CAUSE FE" I ), (b), AND (e)) 1rNr..t rer..ew ewrr w..tM
<br />PI'RT
<br />�
<br />w)
<br />Due A it , 1„Mnwi due*
<br />d— 1 �
<br />(r)
<br />DUN T A ENCE Of- • ; lier""e!F"e""t'"• drrd.
<br />49
<br />k1 «�1
<br />PART eewhiy.tiRe tw ae1 rehled FART
<br />B Ft1EOMANCY
<br />it
<br />IN. Nt FEMALE wA5 TN AUTOPSY
<br />IN TM� FAST S r I (SpeeNr r« « FN)
<br />Tet © No ❑ 2t. NO
<br />WAS CASE >ZI COII O IM 10 N4KA1
<br />!J(A11Mrr[R OR CORONER
<br />iprik Yes w me)
<br />29. Q
<br />ACCIDENT, SUKI MI, NOWCIDL UNNT.,
<br />DATE OF INJ ., *.r, rr.►
<br />N OF 10QURr
<br />1NISCRNE Now IWURT OCCumm
<br />OR mbdw 6 ww""OATw". (Sowdy)
<br />I
<br />j
<br />700.
<br />70b.
<br />30e. M
<br />70d.
<br />Q AT WORE
<br />(Spot* Y« w No)
<br />E 01 RUURY— M tern, Nnet, lwetery,
<br />73:7 yrildias, .tr. (Specify)
<br />LOCATION STREET OR R.F.D. Nee CITY W TOWN STATE
<br />70e.
<br />
|