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<br />! ' D€CfDENf - NA"'f
<br />; Velaura
<br />
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH ANlJ H(JMAN SERVICES
<br />SYSTEAf, IT CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL~~c?gRDP~ FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STAmj11fJ~#?~i!!-t1'CH IS
<br />".~ ...""'--_. ._-- . -..
<br />
<br />::;:::TORYFORVTTALRE~'J fPlJL~R
<br />JUN 2 2 2005 200602.... 79 '.0.' _-_..n. _. _........ _'_.... _..
<br />ASSISTANT STIUE:=REQ/;uRitR
<br />LINCOLN, NEBRASKA HEALTH A~~~A~~i~g:~
<br />
<br />'co' -."c"'c~,::::c""'c i..... ...-:..--
<br />:lIA II: ur NI:lIAA3KA-IHil'AKlMENT OF HEA.LlH AND HUMAN SERVICES FINANCE AJ!DS~~ii:;:c:"':c '. cC;'
<br />VfrALSTAnsncs "'~D' '4~""~O':)'.c:6' 1
<br />CERTIFICATE OF DEATH -.=- . :.... .. ..',"'-.. _"}~
<br />fIRS'" MIDDlE LAST ~ SEw 3 OAlE OF DEATH ~ 0.... ytMtJ
<br />
<br />:.Iinllie Matilda
<br />
<br />Frauen
<br />
<br />t"emale
<br />
<br />
<br />4 cn"'4NOSTATEOFBiRl~ ,M''*'''./JS~ 1'\.tmII'~"
<br />
<br />
<br />uNt}fJ:l 1 "EAR U~DEA l D..v
<br />~ """5 DlVS lie HQUIIS _5
<br />
<br />G CATIE Of 8f'=lll-l ~~" r..,)
<br />
<br />Rural '\It'rid. Cllunr~. ;\ehr;iska
<br />
<br />'In-ember 24. J 920
<br />
<br />, SOC,,,\. SECl.,IA'tI',. NLJ"'8EQ
<br />~1J5-1 b--08S.~
<br />
<br />HOSPItAl. ~,,- ~t"'~R 0 .....""9"""'"
<br /> O~q~ 0 -.....c.
<br /> o OOA 0 00...- 1St1<<'"
<br />sa lN$lOf:: CITY UUlS
<br />
<br />8t) F"ACIUT'Y .NArnIt
<br />Br~'an LG II - East
<br />
<br />/",.,,~ r.~.~S#f"Wttf,.""..,'
<br />
<br />8c co"'.... f~OAt.OC..'!'I()~OI OEAT~
<br />Lincoln
<br />
<br />
<br />ge "'SlOE CItY .IUITS
<br />
<br />9-0 qE$lOEI'lCE. St...
<br />Nehraska
<br />
<br />lIl> COUNty
<br />
<br />k ef'r... T~ORLOCAT~
<br />
<br />.., StllEET AND ~uwe" I""'w.rg~" CoMI
<br />
<br />. Hall
<br />
<br />Grand Island
<br />
<br />v. 0 ...IX!
<br />13 NAMEQFSPouse II(~ (/itwfUlt1!ln,..",.,
<br />
<br />~ 1:) ~.Ace - :e~.""'" SI.lek A,..,>e:,lnlL"tOiH1 11'1 ANCfSTRy I*q ..... JA,IIOCW\ Getman,1ltc.1
<br />
<br />Mltt" I ~tnan
<br />
<br />John Delbert Frauen (Deceased)
<br />
<br />'5 EDUC'TION tS-"""",,_ _
<br />E~DfStcondwy 10.121 ~ 1'.4Of~&1
<br />
<br />'.. "SU'. OCCUPAtiON ,"'...""''''_ _1Vrng""""
<br />rf.ert?r:it "A~STs'fllDt
<br />
<br />Hospiral
<br />L'ST
<br />Ueckert
<br />
<br />(NMI)
<br />
<br />16 ~...n-4ER - NAUE
<br />Arthur
<br />
<br />Flq5t
<br />
<br />"'DOlE
<br />(NI\II)
<br />
<br />17 MOTl-tER
<br />
<br />MAIDEN SUIlNAUE
<br />Ashweige
<br />
<br />"IDDlE
<br />
<br />Sophie
<br />
<br />'8 W'S ~CEASEO EVER IN US AlllAEO FORCES?
<br />I rv~oflO QI~.I Itt';e'S Qtv@<<.......,d>>I!tsQfMtVlCftl
<br />
<br />.....1lliG 'DoqESS
<br />
<br />I t 91 INFOIlMANT. NA"E
<br />Gar}' J.A. Frauen
<br />IStREET OR !IF 0 1'40 CItY OR tOWN SUtE lIPI
<br />
<br />
<br />2,. ..EtHOOOFIlISPosmo" 21.. DAtE
<br />
<br />a1e CEMETERYORCFlF;MATOfh' ~
<br />
<br />Kleine Funeral Home
<br />
<br />1037 ~eu.... DIlo"""" j 03/19/200.., Grand Island Ci~' Cemetery
<br />; 21(; ce~RV OA' CRE~AfOP'1lOCAT~ en v op T~ StATE
<br />Dc.- DO<>noI<< . Grand Island, Nebraska
<br />
<br />22l> FUNERAl MOUE .ooqESS
<br />
<br />IStqEEt OR R.O.D NO City OA tOWN. SUtE.ltP)
<br />
<br />3213 W North front St Grand Island, NE:. 68803
<br />
<br />23 _OIAtE C'USE
<br />PART
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<br />IfPIITE~ CM'<<. Y 0ftE c~us~ PER LINE FOA l'ill Ib):,f,NO ICU
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<br />
<br />It'tter\lil~MIeI ~OI!!~
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<br />P.ln OtHEq SIGNIfICANt CONOItiONS . ~. <~ 10................_
<br />
<br />· Renal failure
<br />
<br />~..al~~iit~':Je~
<br />
<br />,2110
<br />
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<br />26b DAtE OF INJUqy ,'''' o.y Y,/ 2lk;!<OUR OF "",UIlY
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<br />STATe
<br />
<br />l7e DATE OF DEATH IMo D.tll Y, J
<br />
<br />28a DArE SlGltfeo IUQ ~ ~/,
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<br />2lIb TIUE OF (lEAt"
<br />I
<br />
<br />. March 14. 2004
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<br />I f ~ 27b D'TE SIGNED IMo 0,. y"
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<br />132. REGlST...... J.
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<br />1321> DAtE <"ED Bv RtGlSt...R ,..., _ "'I
<br />I APR 1 2004
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