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<br />WHEN'tHIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN$ERVlCES
<br />"' SYSTEM, "CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REORD. ON FtLE.WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA TISnei~tiON. W#/Cli}S
<br />THE LEGAL DEPOSITORY FOR 1IITAL RECORDS. ~id&rij;,;,!;,
<br />
<br />
<br />DAMAR,ss7NZOOZ 20 0 6 0 2 3 2 5 ASS~;.4NT sl1:E~~~~:~
<br />
<br />LINCOLN, NEBRASKA HEAL TH AND ftfJ,MAN SERVlCE_~Sy's~~
<br />
<br />STATE OF NEBRASKA. DEPARTMENT OF HEALTIl AND HUMAN SEKYJtEs f'U'JA.NCcAND SUPPoRT
<br />VITAL STATISTICS - - . ... -
<br />CERTIFICATE OF DEATH
<br />
<br />: 1, DECEDENT. NAME
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />LAST
<br />
<br />2. SEX
<br />
<br />
<br />2497
<br />
<br />. Alfred Donald
<br />14.' CITV AND STATEOF BIRTH {Hnot... iJ,iiA.. rt,me ccuntTYl
<br />
<br />Abbott, Nebraska
<br />7. SOCIAL SECURTlV NUMBER
<br />
<br />Schwie er
<br />Sa. AGE - La$1 Birthday UNDER 1 VEAR
<br />(Vrs.1 5b. MOS. DAVS
<br />84
<br />
<br />Male
<br />UNDER 1 DAV
<br />Se HOURS: MINS
<br />
<br />2002
<br />(_, Day. Y~r)
<br />
<br />8 1917
<br />
<br />Ba. PLACE OF DEATH
<br />
<br />Bb. FACILITY. Nama
<br />
<br />(N not insHtuJion. 91va ,_,00 numbor)
<br />
<br />HOSPllAL: ~ Inpatient
<br />D ERQulpationt
<br />D DOA
<br />
<br />OtHE.R: D Nl,lrSinlij Home
<br />
<br />D Residenco
<br />D OIhor (Speedy,
<br />
<br />508-18-0057
<br />
<br />St. Francis Medical Center
<br />6<:. CITV. TQWN OR LOCATION OF DEATH
<br />
<br />'B. FATHER. NAME
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />
<br />ed, INSIDE CITV LIMITS
<br />
<br />Grand Island
<br />9s, RESIDENCE - STATE
<br />
<br />Nebraska
<br />
<br />
<br />9<1. STREET AND NUMBER {lneW"!} Z., Codel
<br />
<br />90. INSIDE CITY LIMITS
<br />
<br />Hall
<br />
<br />Cottage 68803 v..1XJ No D
<br />13. NAME OF SPOUSE Iff wile. giva m,kJen ",me)
<br />
<br />10. RACE. (e.g.. White. Black;. American Indian.
<br />eIOlISpecily, White
<br />
<br />11. ANCESTRY fe.g,. nalian, Mexican. Getman, etC!
<br />(Specify, American
<br />
<br />Ella Mae,Mo er
<br />15. EDUCATION (Specify ooly highoSl grade complotod'
<br />EIo~nttryo<~on<laty 10-'2)' College 1'.40'5"
<br />lStn I,;rade
<br />MIDDLE MAIDEN SURNAME
<br />
<br />14a. USUAL OCCUPATION {Give kind 01 work done during moot
<br />01 worki"!} /lie, 0_ H reti'"'"
<br />Welder
<br />
<br />August Eliese
<br />'B, WAS DECEASED EVER IN U.S. ARMED FORCES?
<br />
<br />Ivoy;;Unk,) flfiigiVi75'''?ite~r43rv~i)2/ 6/1945 Ella Mae Schwie er
<br />
<br />19b. INFORMANT MAILING ADDRESS fSTREET OR RF,D. NO." CITY o.R To.WN. ST ATE. ZIP)
<br />
<br />Behrens
<br />
<br />2804 W.
<br />
<br />Grand Island. Nebraska 68803
<br />2,.. METHOD OF DISPOSITION 21b, DATE
<br />
<br />210. CEMETERV OR CR~MATORV - NAME
<br />
<br />
<br />. !XI Burial D Removal Mar. 5. 2002 Wes tlawn Memorial Park
<br />2'd, CEMETERVOR CREMATORV LOCATION CITV OR TOWN STATE
<br />
<br />Livingston-Sondermann F.R. DCtemallon Dllona,IOO
<br />22b. FUNERAL HOME ADDRESS ISTREET OR RF,D, NO.. CITY OR TOWN, STATE, ZIP)
<br />
<br />Grand Island. Nebraska
<br />
<br />601 N. Webb Road, Grand Island, Nebraska 68803-4050
<br />23. IMMEDIATE CAUSE fENTER ONL V ONE CAUSE PER LINE FOR lal.fbl, AND (ell
<br />
<br />.-t"~R:1 1l..1..SIIl1..A:rl)1t y ~A-/GIAIll
<br />
<br />DUE TO, OR AS A CONSEOUENCE OF, .
<br />
<br />(bl I'AJ~NIA
<br />DUE TO, OR AS A CONSEQUENCE OF'
<br />
<br />Interval between onset and dealh
<br />+-
<br />
<br />J,.w "- J
<br />
<br />Interval between onset: and death
<br />
<br />Interval t>9lween onset and death
<br />
<br />lei
<br />PART OTHER SIGNIFICANT CONDITIONS - Condlflons contrlbU1l"9 to tho d.ath but not ,.Iated
<br />
<br />If {}~ h I l
<br />
<br />0 Accident D UndetermIned
<br />0 SUlcil1e 0 F'ending 260. INJURV AT WORK
<br />0 Homicide Investiga1ion YesD NoD
<br />
<br />M
<br />26f. ~;6ull~i~J~.Y itj;g/&!' larrn, !>Ireet.factory 26g. LOCATION
<br />
<br />
<br />
<br />:reo.
<br />
<br />STREET OR R.F.D. NO.
<br />
<br />CITY o.R TOWN
<br />
<br />STATE
<br />
<br />27a. DATE OF DEATH (Mo.. Day. y,)
<br />
<br />2Ba. DATE SIGNED (Me.. Day, YO
<br />
<br />2Bb. TIME OF DEATH
<br />
<br />
<br />...r-
<br />
<br />x~
<br />J;~~ ~
<br />.ll '" ~ 28c, PRONOUNCED DEAD {MO.. Day, Y'I
<br />~;l:S,,;
<br />j"'i':~
<br />1:ffi~
<br />.eL
<br />8 ~
<br />
<br />M
<br />
<br />28d, PRONOUNCED DEAD (Hwt/
<br />
<br />M
<br />
<br />r
<br />
<br />~NO
<br />
<br />32b. DATE FILED BV REGISTRAR
<br />
<br />MAR
<br />
<br />Nf:. to f~3
<br />
<br />(Me.. Day Yr.)
<br />6 2002
<br />
<br />fYI.b.
<br />
<br />Cd ("C{./'l J( I~ I U-yt c9.
<br />
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