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<br /> ~ i <br /> (\:::l r...:o <br /> -, ~ c"> (J) C) <br /> c.f\ ==> o -i <br /> ('\ () <:J"I <br /> ~ ~~ c::t> N [ <br /> :-\ :J: ~ Z ;z-i <br /> ~ ~~ <::;;) -ifTl C) <br />N c: ::r: c:::: -<0 G:- <br />G n Z x N 0""" 0 <br />G T :I:~g ~ CD """z en 3" <br />CJ1 ..., <br />...... F rn . .. r :J:111 ..- I <br />(')tfl 0 :z::,.OJ <br />...... "'::X: rTl -0 r-::o <br />-..,J rTl ::3 r-:t> ..- <br />...... (:) <br />lXl c.r> (f) -l <br /> \ t'-' ~ <br /> :t> ..- <br /> f"0 .......-- <br /> a co (f) 0;;> 2 <br /> (f) 0 <br /> <br /> <br /> <br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN"ERVlCES <br />SYSTEM, "CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECORgp~ FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAT/~l,!f;S'~F'J~Hi:l'tHICH IS <br /> <br /> <br />=s;;~~;;:;YF:;;;:7~ 18 ftrj~~~ <br /> <br />LINCOLN, NEBRASKA HEAL TH Al!DHl{MAN'SER~SlrstfM <br /> <br />., ,'. '0_. ..~,~.' .o:;;}" _5,-;' <br />-~ -_ .-::::=,-:':-.;;~~~,:z. .:::::: <br />. ,. .J ,::-::_':-:',';':"'.",'~,:~_. -- <br />STATE Of NEBRASKA - DEPARTMENT OF HEAL.. TN'-' c'..' . '.' .... .'.:...9<-.:1'.".' ..' ('::-1'- 03 8 2 <br />BUREAUOFVITALSTATISllCS ,'t.-O.__"". ..' " <br />CERTIFICATE OF DEATH >- ~-" ,./J---. . <br /> <br />1. l'lE NT. NAME FIRST lllDDl.l' -- C-AST 2, SEX 3, DolTl' OF OE.\TH(_. l;lIy. YMIJ <br /> <br />= <br />~. <br /> <br /> <br />Akron, Nebraska <br />7. sacw.. SECURITY NUM8eR <br /> <br />Sa. olaE . Last_v <br />'Yr"76 <br /> <br />51>. MOS./ <br />I <br />I <br /> <br />DAYS <br /> <br />IIC,HOIJIlS: <br /> <br />llINS. <br /> <br />September 25, 1991 <br />e. DolTE OF BIRTH (_. o.y. Y_} <br />August 21, 1915 <br /> <br />Melvin <br /> <br />LaVern <br /> <br />Hinze <br /> <br />Male <br /> <br />.. C olNOSTolTEOFBlIlTH (1fOlO/ir.U.S.A..__; <br /> <br />506-40-0820 <br />111>. F,lClLln;._ <br /> <br />HOSPITAL: <br /> <br />Home: R.R.l Box 213 A <br />k RESlDrHOE. ST.UE <br />Nebraska <br /> <br /> <br />Cairo <br />9c. CITY, TOWN OR LOCATION <br /> <br />Cairo <br /> <br />e.. lN6IDE CITY tMlTS <br />/$pedy 1'""", I'Ia! <br />No <br />13. NAalE OF SPOIJSl! (It......".. __ <br />Margaret M. Schmeits <br /> <br />10. RolCE. I_.g.. WIlilo.Illacil. _lull I""'.'. ". olNCESTllY ,_.g.._. ~.ican. altman. <IIe.1 <br />"'.1 f~i/y) (S{Mc/fy} <br />Whi te American () l. <br />14 USUALOCCUPATION(~k""'d__dullng_ <br />d~._if"') \C\ <br />Owner/Operator b Motel <br />.11. FolTHEA . NAME FIRST lllDDl.E C-AST 17. llOTHER. llollDliN NolME <br /> <br />CoIlaee (1-4 '" $-1 <br /> <br />FIRST <br /> <br />(.A$T <br /> <br />Celia Nott <br />(STIlEET OIl A.F.O. NO.. CITY OR TOWN. STolTE. ZIP) <br /> <br />, NE 68872 <br />:zoa. LOColTION CITY OR TOWN <br /> <br />STATE <br /> <br />Akron, Nebraska <br />ISTRfET OR R.F.D. NO.. CITY OR TOWN. STolTE. ZlPI <br /> <br />A fel-Butler-Geddes 1123 W. 2nd, Grand Island, NE 6880: <br />lnIonool____ <br /> <br />Minutes <br />----- <br /> <br />DUE TO. 0f'I ,lS A CONSEOUENCE OF: <br /> <br />----- <br /> <br /> <br />PolAT OTHl<F1 SlGNIFlColNT CONDITIONS. CMoli_ _"lito _ Il\lI nOl rai_ <br />n <br /> <br />2.. "'UTOPSY <br />(S{>>ctfy Y.. '" No; <br />noD NolJ No <br />i/6d. DliSCll(~r HOW INJUIlY OCCURRED <br /> <br />21\. W,lS CME REFERRED TO MEDICAL <br />EXAMINfR OR COIlClHER? <br />tS/>M:lfy Y.. Of NoI Yes <br /> <br />i/8II. INJUIlY olT \\/OaIl <br />. (Sp<<ily -,i", '" No) <br /> <br />mEETOAK .'- . <br /> <br />CITY Of', TOWN <br /> <br />STATE <br /> <br />27a. DolTE OF DEATH <br /> <br />21lb. TIllE OF OE.\TH <br /> <br />il i 27b. DolTE SIGNED (Mo.. o.y, Yr.} 270. TillE OF DEATH <br /> <br /> <br />! f 270. To Il1e _ 01 my k~. _ __ 11... b..... _ _ pla<:a and 01>1"''''' <br />..... cau.(s;' .u.d. <br /> <br />and Tille " <br />2111 0'') TOIIACCO USE CONTRIBUTE TO THE OE.\TH? <br /> <br />4:00 <br /> <br />approx. <br />p <br /> <br />280. PAONOUNCED DEAD /Houo/ <br /> <br /> <br />o YES <br /> <br />ONO <br /> <br />o YES no <br /> <br />Office, Grand Island, NE <br /> <br />321>. DollE F_'STl _yr.1 <br /> <br />~c.;,'JC&o5;). <br /> <br />\"- <br />