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<br />MIEN THIS COPY CAMMS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HWAN SEES
<br />SYSTEK IT CERTMS THE BELOW TO BE A TRUE COPY OF THE ORIGINAL =Ei WILE I0H
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL SrATr_ "IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS _
<br />DATE OF ISSUANCE
<br />JUL 3 0 2003 ft-—mLky-.&
<br />COOPER
<br />LINCOLN, NEBRASKA 260 1gl2�1HEALTH AAND ItAkSERVICESSYNITM
<br />STATE � MPAI NW OF MALTH A OF YRAL-STMMKS = `v
<br />Coi wft ►Te of o`E►TM jr)
<br />1. DMIDEW -NAVE FIRST mom LAST
<br />2$ot
<br />S. TE DEATN AW4aysYIN
<br />Charles. Ronald Babel
<br />n
<br />June 3. 1992
<br />4.0WANDWATEOFSKTH INrof 41 U.SA, A.,M munlYl - -
<br />6L ASE - L"A"
<br />R -DATE OF @RTH A.mrc mW yool -
<br />m
<br />Central City, Nebraska
<br />72
<br />Ammst . 13, 1919
<br />f P 1 QXYpWW o EWOM OM. d DOA
<br />505 -16 -0770 ! o N.tait10WRr C R ..- ,. o OmR(SO,esy)
<br />Td FAMITY "w", Irro1 rssRl.srt ew s...NSnr r.s..ar'
<br />Oe. CRY. TOWN OR LOCATION OF DEATH
<br />rd INSIDE CITY LJMSTB
<br />S.. C0WM OF
<br />Saint Francis Medical Center
<br />.
<br />Grand Island
<br />awe&* Ya 6r.Ab/
<br />yes
<br />Hall
<br />c;
<br />r
<br />.a CITY. TOWS OR LOCATION $d. STREET AND MLOW Af hOW 20 DDMW
<br />ft CR'Mf�
<br />Nebraska
<br />Hail
<br />Wood River 207 W. 13th
<br />es "
<br />- sa RICE -1.0. WI,1., SIHICk. Amaloln.Ielut.
<br />1t. ANCESTRY 1•- 4JM•�A. IA.ICNM1. C+xOI.HI.1 12 VARR1EOAFJER MUSSED.
<br />13. NAME OF SPOU6E AltaSr. O+r AN..Ay �' -
<br />40.! R mwo
<br />White
<br />( MRDOMMED. oIIRORCED Ab wYl
<br />German. 10 Married
<br />-
<br />Mary F. Barr
<br />14L USIM OGMWATION KMASMoaar.,ft.IO11. APf7o mOM
<br />Ift low Or tUEiNk =INDUSTRY
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<br />-
<br />16; FATHER - NAME FIRST - MIDGES LAST
<br />17. MOTHER • MAIDEN NAM FIRS, MIDDLE LAW _
<br />Charles A. Babel
<br />Veda -" Z. Hansen
<br />�o n
<br />EVER R U.S. ARMED FORCES? 1S. INFORMANT - NAME - MAArfo ADDRESS (STREET OR "A. NO. CRY OR TOWN, STATLAM
<br />(7
<br />CA
<br />;
<br />. 20.. WJFNM. CwIrYolpR.s10YN, 200. DATE
<br />2.C. COWFOW OR CREMATORY - NAME at
<br />T-
<br />71C
<br />Burial June 6, 1992
<br />-'
<br />m
<br />7C
<br />2
<br />22 n t1ERAL NOME - 0MME AND AGGRESS (STREET OR RFJM N0: CITY OR TO.MR. STATE, 2P)
<br />A fel Funeral Home, Box 126, Wood River, Nebr, 68 ;
<br />2 PART' MUNDIAW CAUSE JENTER ONLY ONE CAUSE. PER LINE F� Iei(, (b(, AND kfl
<br />w,
<br />DUE TO, OR AS A CONSSO t = OF!
<br />/ IItGYA1..w.nanMdMaY
<br />-
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<br />I
<br />P OTHER SOMFICANT n.N CONDITIONS - C04660M C. W&V ID 01W Out nW reIMW PART R R FEMALE WAS THERE A
<br />24. AUTOPSY
<br />2!L WAS CASE tIS�D TQ
<br />PREGNANCY IN THE PAST 3 MONTHS?
<br />/8pabo MDj
<br />EYAi1RYEl1 OR
<br />/SP1'Ymtor,ly
<br />Y.. 0 No L7
<br />'=t
<br />260. DATE OF WAIRY AW)w, YLj
<br />26e. HOUR OF KAM
<br />DESCRIBE NOW SNJURY OCCURRED
<br />Ott PENDIMIG ONEST009W IN%l+k*)
<br />128d
<br />-
<br />2D.. NVURT AT YIfOfK
<br />RACE OF WJRY - At tww. Imo WYK b0m,,
<br />(D
<br />o
<br />aRrs mata'r g. oft. (SS+cwI
<br />27L DATE OF DEATH PAL Dg, WJ
<br />�
<br />20L DATE SINNED (Y0. D4& Yr.I!
<br />200. TIME OF DEATH . -.
<br />— 3 p
<br />C-0
<br />270. DA IM1fiM (Ma.OW.Yr)
<br />Y7a TIME DEATH -
<br />Mb. PRONOUNCED DEAD Ma, .Yr.I'
<br />W& PRONOUwwDEAD p+IfMHN
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<br />27L To 21. HN.I d my bt•M••2•, d,.m a.M ma W.D. and Ow b tM
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<br />DID TOSAOCO USE CONTRWilTE T OUT UK HAS ON" OR, nISsm DONATION SEEN WNSWRE 7
<br />90L WAS LO WENT GRANTED?
<br />G YES O UNKNOWN
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<br />MIEN THIS COPY CAMMS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HWAN SEES
<br />SYSTEK IT CERTMS THE BELOW TO BE A TRUE COPY OF THE ORIGINAL =Ei WILE I0H
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL SrATr_ "IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS _
<br />DATE OF ISSUANCE
<br />JUL 3 0 2003 ft-—mLky-.&
<br />COOPER
<br />LINCOLN, NEBRASKA 260 1gl2�1HEALTH AAND ItAkSERVICESSYNITM
<br />STATE � MPAI NW OF MALTH A OF YRAL-STMMKS = `v
<br />Coi wft ►Te of o`E►TM jr)
<br />1. DMIDEW -NAVE FIRST mom LAST
<br />2$ot
<br />S. TE DEATN AW4aysYIN
<br />Charles. Ronald Babel
<br />Male
<br />June 3. 1992
<br />4.0WANDWATEOFSKTH INrof 41 U.SA, A.,M munlYl - -
<br />6L ASE - L"A"
<br />R -DATE OF @RTH A.mrc mW yool -
<br />(Yn.1 .L IAOB. DATE
<br />Central City, Nebraska
<br />72
<br />Ammst . 13, 1919
<br />f P 1 QXYpWW o EWOM OM. d DOA
<br />505 -16 -0770 ! o N.tait10WRr C R ..- ,. o OmR(SO,esy)
<br />Td FAMITY "w", Irro1 rssRl.srt ew s...NSnr r.s..ar'
<br />Oe. CRY. TOWN OR LOCATION OF DEATH
<br />rd INSIDE CITY LJMSTB
<br />S.. C0WM OF
<br />Saint Francis Medical Center
<br />.
<br />Grand Island
<br />awe&* Ya 6r.Ab/
<br />yes
<br />Hall
<br />ft - w7ATB
<br />,.. COUNTY
<br />.a CITY. TOWS OR LOCATION $d. STREET AND MLOW Af hOW 20 DDMW
<br />ft CR'Mf�
<br />Nebraska
<br />Hail
<br />Wood River 207 W. 13th
<br />es "
<br />- sa RICE -1.0. WI,1., SIHICk. Amaloln.Ielut.
<br />1t. ANCESTRY 1•- 4JM•�A. IA.ICNM1. C+xOI.HI.1 12 VARR1EOAFJER MUSSED.
<br />13. NAME OF SPOU6E AltaSr. O+r AN..Ay �' -
<br />40.! R mwo
<br />White
<br />( MRDOMMED. oIIRORCED Ab wYl
<br />German. 10 Married
<br />-
<br />Mary F. Barr
<br />14L USIM OGMWATION KMASMoaar.,ft.IO11. APf7o mOM
<br />Ift low Or tUEiNk =INDUSTRY
<br />�i�
<br />Insurance
<br />Sales
<br />-
<br />16; FATHER - NAME FIRST - MIDGES LAST
<br />17. MOTHER • MAIDEN NAM FIRS, MIDDLE LAW _
<br />Charles A. Babel
<br />Veda -" Z. Hansen
<br />16. WAS ONCEASED
<br />EVER R U.S. ARMED FORCES? 1S. INFORMANT - NAME - MAArfo ADDRESS (STREET OR "A. NO. CRY OR TOWN, STATLAM
<br />(YHft&wk)
<br />ISVft .•W••eam"Gfmmlw;
<br />es
<br />WW2 1939 -1945 Mary Babel - P.O. Box 38, Vood- River, Nebr. 68883
<br />. 20.. WJFNM. CwIrYolpR.s10YN, 200. DATE
<br />2.C. COWFOW OR CREMATORY - NAME at
<br />LOCATION CITY OR TOWN: - : -.- : 8t/1}E.
<br />Burial June 6, 1992
<br />Grand Island Cemeter
<br />Grand Island, Nebraska
<br />21. ELN.f1►TUI(S 710. yy
<br />22 n t1ERAL NOME - 0MME AND AGGRESS (STREET OR RFJM N0: CITY OR TO.MR. STATE, 2P)
<br />A fel Funeral Home, Box 126, Wood River, Nebr, 68 ;
<br />2 PART' MUNDIAW CAUSE JENTER ONLY ONE CAUSE. PER LINE F� Iei(, (b(, AND kfl
<br />!I'L� TK I
<br />DUE TO, OR AS A CONSSO t = OF!
<br />/ IItGYA1..w.nanMdMaY
<br />,�' .t��d.
<br />A i 11WMLO1mw" PMR'w
<br />I
<br />P OTHER SOMFICANT n.N CONDITIONS - C04660M C. W&V ID 01W Out nW reIMW PART R R FEMALE WAS THERE A
<br />24. AUTOPSY
<br />2!L WAS CASE tIS�D TQ
<br />PREGNANCY IN THE PAST 3 MONTHS?
<br />/8pabo MDj
<br />EYAi1RYEl1 OR
<br />/SP1'Ymtor,ly
<br />Y.. 0 No L7
<br />UL SOME. HOA11 M- UNDET,
<br />260. DATE OF WAIRY AW)w, YLj
<br />26e. HOUR OF KAM
<br />DESCRIBE NOW SNJURY OCCURRED
<br />Ott PENDIMIG ONEST009W IN%l+k*)
<br />128d
<br />-
<br />2D.. NVURT AT YIfOfK
<br />RACE OF WJRY - At tww. Imo WYK b0m,,
<br />2d0. LOCATION STREET OR 0.FA. NO. CRY OR TOWN STATE . -
<br />IB,AC/YYes or RM
<br />aRrs mata'r g. oft. (SS+cwI
<br />27L DATE OF DEATH PAL Dg, WJ
<br />�
<br />20L DATE SINNED (Y0. D4& Yr.I!
<br />200. TIME OF DEATH . -.
<br />— 3 p
<br />--
<br />270. DA IM1fiM (Ma.OW.Yr)
<br />Y7a TIME DEATH -
<br />Mb. PRONOUNCED DEAD Ma, .Yr.I'
<br />W& PRONOUwwDEAD p+IfMHN
<br />��[[
<br />(_
<br />fe
<br />27L To 21. HN.I d my bt•M••2•, d,.m a.M ma W.D. and Ow b tM
<br />2,a On ri. m" of "w"o.0" wwor, ,R+••a$•r•n In fit "l mm Ot1Mt . a.DIM" M
<br />Dntis(N.IMS.•
<br />s
<br />.w..n,, aw.na FYct rM aw a.r o.w.(N NMMa.
<br />DID TOSAOCO USE CONTRWilTE T OUT UK HAS ON" OR, nISsm DONATION SEEN WNSWRE 7
<br />90L WAS LO WENT GRANTED?
<br />G YES O UNKNOWN
<br />-
<br />" MW ANO ADONEWN CENTWER 1PHYSICAN. CORDNE" PNY$ICAN OR COUNTY ATTORNEY] ;Tjms er Pr" -
<br />glary SettNt Min, 908 N. Howard Av. Grand Island, Nebraska 68802
<br />22L flE01STRIM - 30. DATE BLED SY REGRTRAR AW. Day. riJ -
<br />_, m1s
<br />
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