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<br /> '" Q%c .......:0 ~I <br /> !:R c:::;> c;")(J) <br /> c:::> <br /> , c: m en c:..r> o -i <br /> n::c ~~ c:J> <br /> ("")n z '" Cl Z-i <br /> 0 ,....,.., -il'Tl <br /> ,.. ~> ~ CJ -<0 <br />N t ncn 0\ ~ 0"'" air <br />s "':x: " f'\J ..." z ~I <br />s j If\ CJ ~ :r l'Tl <br />(J1 rT'l -0 )> ea <br />~ \) rn t :::3 r :;0 <br />N Cl r l> <br />~ (/l (J) <br />(J1 ca ;::><: <br />0') )> <br /> U1 -- en..... <br /> CJ'1 (.f) <br /> 1ft ~ <br /> <br /> <br /> <br />Lot One (1), in Block Two (2), Boggs and Hill's Addition to the City of Grand Island <br />County, Nebraska. ' <br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVlCES-- <br />SYSTE'M. "CER71FIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVlCES SYSTEM, VlTAL STATISTICS SECTION, WHICH IS <br />THE LEGAL DEPOSITORY FOR VlTAL RECORDS. J. IT ~ <br /> <br />DA TE OF ISSUANCE MA1hU yJ. wvtf. <br />FEB 2 5 Z003 )VV""VgANLEYS. COOPER <br />2 0 0 51215 6 ASSISTANT STATE REGISTRAR <br />LINCOLN, NEBRASKA u . HEAL TH AND HUMAN SERVlCES SYSTEM <br />STAlE OF NEBJlASKA- DI!PAlllldENT OF HE.AUH AND HUMAN SER.VICES FtNANCE AND SlII'I'ORT <br />VITAL STAnmcs <br />CERTIFICATE OF DEATIi <br /> <br />Hall <br /> <br />03 <br /> <br />01912 <br /> <br />'.DECroE/IT.NAME <br /> <br />FIRST <br /> <br />"'OOLE <br /> <br />LAST <br /> <br />2. sex <br /> <br /> <br />(MoIIIh. o..y. Y_I <br /> <br />Thomas <br />.. CITY AHllSTATEOF BIRTM ,.""'" SA._CQJII/Iyl <br /> <br />Eu ene costello <br />50. AClE. UooI 8I"'y UNllEII . YEAR <br />rr".1 5b. lAOS. OlI.YS <br /> <br />Jan 30 2003 <br />e. llATE OF BIRTH (_ Do,. Y"" <br /> <br />Male <br />. UNDER I lIA Y <br />k- HOuRS I I'INS <br /> <br />17 1928 <br /> <br />Grand Island, Nebraska <br />1. ~ RTIY Nl/MBER <br /> <br />74 <br />lIIL PI.ACl! Of lleATH <br />~ 00...... <br />DER~ <br />o OOA <br /> <br /> <br />.0 Nursiog t"tofM <br />o _idon<. <br />o ot>er (S<I<>c'1y1 <br /> <br />OTHER: <br /> <br />506-28-7.663 <br />Ill. FAClUTY._ <br /> <br />(W""'__,..--~ <br /> <br />Saint Francis Medical Center <br />... CITY. T O'HOCATION Of IlEATH <br /> <br />... INSlllE CITY UI.llTS <br /> <br />Grand Island <br />... RE5I . STAlE <br /> <br />lid. STREET AHDNUMBEA ("",WkJgZir>~1 <br /> <br />68803 <br /> <br />..b K1Nll OF IlUSlNESS INDUSTRY <br /> <br />Elizabeth Smith <br />IS. EDUOA TION (SpocJfy ""Iy highO$ll'- eomplolo<lJ <br />12Soc:ood01y 10.12)' ~Iogo 1'-<'" 5" <br /> <br />MIDOLE MAIDEN SURNAME <br /> <br />17 lAOTH~R <br /> <br />Ma Elizabeth Reill <br /> <br />Costello <br /> <br />1903 W. 13th Grand Island Ne 68803 <br />2ll EMIIAlMEA.SlGHATURElucecsENO. 21o.l'ETHDDDFOISPOSITlON 2.1>. lIATE <br /> <br />21e CEI'ETERY OR CREI'A TORY. NAME <br /> <br /> <br />',. <br />00- DRoinev.. Feb 3, 2003 Grand Island City <br />210. CEMETERY OR CRElAA TORY lOCAT1ON CITY OR TOWN <br /> <br />D~ D~ 3168 w. stolle Park 'Rd. Grand Island NE <br /> <br />1078 <br /> <br />STATE <br /> <br />, Curran Funeral Cha e1 <br />ZI!b. FUHERALHlJUEAOOflESS I REETORR./'.D'.NO_CITYOATOWlI.STATE.Z1pt <br /> <br />3005 South Locust Street Grand Island NE 68801 <br />1!3. IWMI!DIATI! IfHTEA ONLY ONE CAUSE PEA ~ FOR 101. Ibl. AHO (ell <br />PART <br />'w Acute Subdural hemorrhage <br /> <br />llUE TO. OR AS A CONSEOI..EI<<:: OF: <br /> <br />InII..-v" ~ onI8I and death <br /> <br />unknown <br /> <br />lnIonIal_ """"' ond doo" <br /> <br />,.. <br />IlUE TO. OR AS A CON E OF: <br /> <br />lei <br />PART OTtSl SlGNFlCAt.'T CONllITlOMS - c..--.. ~ "'... doo"WI1Ol ,- <br /> <br />ndumonitis &,hypertensive cardio- <br />2So. INJURY /lit>.- 0.,-, rtJ :!ll<. HOuA OF tlJUflY <br />Dd~EJS~ <br />0- OP""""'O <br />0- ~ <br /> <br />Mo. INJURY AT WORI< <br />v.. 0 .... D <br /> <br /> <br />;!ftv. lOCATION <br /> <br />STREET OR RF .0. NO. <br /> <br />CITYQRTOWN STATE <br /> <br />210. llATE OF llEATH IMD.. Do,. Yt.) <br /> <br />280. llA TE SIGNED (""'.. o.y. Y'.I <br />20 I 200 <br /> <br />(i,Ia.Ooy. Yi''' <br /> <br />211b. TIME OF DEATH <br />10:05 am <br />M <br /> <br />EI <br />hi <br /> <br />27lI. llATE SIGNEll /uo-".,. Yi'J <br /> <br />21e. TIME Of IlEA TH <br /> <br />M<l. PRONOUNCED llEAll {Ho<JI1 <br />amM <br /> <br />1,1 <br /> <br />214 To... _ CI ""'............ clOdI......."" ..... _. _ .., _ ... - 0> "'" <br />_0'- <br /> <br /> <br />". NAME AHll AOOAESS OF CEffi1f1Ell IPHY$ICIAH. 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